![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by maureen on July 2, 1999, at 21:07:23
I read this term in an online article and was wondering what it is ? Eye movement desensitization therapy. Is this a common practice and do therapists tell you if they are using this therapy on you?
Posted by cynthia on July 2, 1999, at 22:35:03
In reply to eye movement desensitization, posted by maureen on July 2, 1999, at 21:07:23
> I read this term in an online article and was wondering what it is ? Eye movement desensitization therapy. Is this a common practice and do therapists tell you if they are using this therapy on you?
Hi Maureen,
You'd most definately know if a therapist was using this therapy. Look in the June achives; there is a running 'conversation' between DL and a psychiatrist named Toby about EMDR. I believe it is used for people who suffer from PSTD or have been abused in their past. I'm planning to try it eventually. If you try it and it works, please let me know.
Cynthia
Posted by Toby on July 6, 1999, at 11:55:04
In reply to Re: eye movement desensitization, posted by cynthia on July 2, 1999, at 22:35:03
EMDR has been used since about 1986 and is becoming more common in helping people deal with traumas, both large traumas like rape and near death experiences, but also with what they are calling "small t" traumas that are things like phobias, panic attacks, poor self esteem issues from being put down by important people early in life, anger, divorce, and the like.
The therapist would indeed tell you EMDR is being done and you would have to agree to it before anything was started. There are no trances or hypnotic states induced. And nothing is actually "done to" you, it is just a technique to get your mind to focus on important aspects of whatever incident you are working on and to resolve them such that they recede into a proper "memory state" and quit having such an impact on your current life.
For more details and access to where therapists are in your area, look at www.emdr.com.
Posted by ANNIEM on July 7, 1999, at 6:01:55
In reply to Re: eye movement desensitization, posted by Toby on July 6, 1999, at 11:55:04
> EMDR has been used since about 1986 and is becoming more common in helping people deal with traumas, both large traumas like rape and near death experiences, but also with what they are calling "small t" traumas that are things like phobias, panic attacks, poor self esteem issues from being put down by important people early in life, anger, divorce, and the like.
>
> The therapist would indeed tell you EMDR is being done and you would have to agree to it before anything was started. There are no trances or hypnotic states induced. And nothing is actually "done to" you, it is just a technique to get your mind to focus on important aspects of whatever incident you are working on and to resolve them such that they recede into a proper "memory state" and quit having such an impact on your current life.
>
> For more details and access to where therapists are in your area, look at www.emdr.com.Toby,
How effective is this treatment? Can it be used as a short term therapy or is or is done in conjuction with other types of treatment? Thanks.
Posted by Toby on July 9, 1999, at 12:51:19
In reply to Re: eye movement desensitization-? for Toby, posted by ANNIEM on July 7, 1999, at 6:01:55
> How effective is this treatment? Can it be used as a short term therapy or is or is done in conjuction with other types of treatment?
It is highly effective for the traumas I mentioned in the other post. For a while it was thought that Dr. Shapiro (who "discovered" this) was making up her data in her research papers because the percent of people getting and staying better was so high (like almost 100%) but there have now been more research papers published on this form of therapy for trauma than on any other treatment and all show EMDR to be highly effective. There are some "review" papers that focus on some early research done by people who wre not trained in EMDR and who did some sort of "finger-waving" that they said was EMDR but in fact was not, and of course it got terrible results and so these reviewers say EMDR is not effective. But from my own experience and that of others who use it, it is effective for nearly everyone; even those who have some, shall we say, "reason" for not getting better (disability, lawsuit, dependency issues) and will say to me, "I'm not better," it still is clear from who differently and better they function that some effect has been had.
Anyway, second question: For single traumas or phobias or "simple" issues, EMDR can be used in 1-3 or 4 sessions with pretty much complete resolution of the problem. For someone who has been abused from childhood or had other extensive or long-term trauma, EMDR is often used in conjunction with regular talk therapy or other modes of therapy like relaxation, medications when needed, etc. It won't cure things like depression or psychosis, but can be used in conjunction with meds so that the issues that seem to weigh a person down and perpetuate the depression can be relieved and also in psychosis to improve functioning (and also guilt or hopelessness about having a mental illness).
Posted by Elizabeth on July 11, 1999, at 19:18:50
In reply to Re: eye movement desensitization-? for Toby, posted by Toby on July 9, 1999, at 12:51:19
Toby,
Could you describe in a little more detail what you consider to be the best research on EMDR?
As far as Francine Shapiro goes, I think one reason people doubted her was because her credentials appeared rather dubious; however, I can't recall the details.
It has also bothered people that there is no theoretical basis for why the "EM" component of this treatment *should* work. (That doesn't mean that it doesn't work, however.)
Another issue that has come up is the fact that EMDR is being used for a wide variety of disorders - some of them are things one would expect it to help with, such as simple phobias and PTSD-related fears, but it's also been claimed to cure panic disorder, eating disorders, addictions, and a variety of other things.
It has also been claimed that it works extremely fast, and many clinicians and researchers are skeptical of this. I'm heartened by your more moderate approach.
I think that if the empirical data say it works, that's good, although in the absence of a theoretical reason why it might work, we need to be extra-careful that the studies showing it works are well designed and in particular are well-controlled.
I'm not doubting your professional experience; rather, I'm asking you to answer the questions that have been asked by skeptics, because I really haven't had much of a chance to speak to anyone about it who does believe it works. I would like to hear both sides of the issue. (I literally cannot find anyone locally who is in favor of the use of EMDR. If you know of someone in the Boston area who'd be willing to talk to me about it, I'd be delighted. This is out of curiosity only, not because I require treatment of this sort.)
Posted by DL on July 16, 1999, at 9:04:43
In reply to Re: eye movement desensitization-? for Toby, posted by Toby on July 9, 1999, at 12:51:19
>EMDR is often used in conjunction with regular talk therapy or other modes of therapy like relaxation, medications when needed, etc. It won't cure things like depression or psychosis, but can be used in conjunction with meds so that the issues that seem to weigh a person down and perpetuate the depression can be relieved
EMDR has been helpful to me in therapy to bring things up to the surface so I can look at them in a new light. From my recent experiences with a good therapist I would say that it is important to have EMDR with a therapist who really knows how to work with what is dredged up for a new appraisal. There were some things that were sudden eye openers to me that seemed to release me from a perception of an incident that was formed long ago. I started with things never really processed from my childhood (a long time ago!)and seemed to move toward the present, with some irratic bouncing back and forth. I never really left an EMDR session saying "Wow, well that's all set now", but rather as I look back now I can say that some of those things are not popping into view and guiding how I react as much now. When I think of some of the painful things now I don't stop breathing, intensely focus on them, feel close to tears or go into an alert status. These things have not disappeared from my consciousness, and some of them still interfere with or tinge my perception of daily events. But, some of the things have become more muted. I know this is probably not a great description, but it's the best I can do.
I know I still have a ways to go. MY EMDR sessions fit in as needed. Sometimes I go prepared for one and it turns out that I don't get to it because something comes up and discussion seems to be working. I still get worked up when I know I will have a session. I think I am afraid of what will come up--or that nothing will! But I am fine once it starts and the therapist is great.
TOBY, how am I doing here?? Making sense?? Does it look like I am going somewhere with this?
QUESTION:
I need a comment--
The therapist has suggested we do a "positive" EMDR. Most of mine have jumped right into painful stuff. Yesterday in a regular session, she was working on getting me to recognize GOOD attributes in myself. For some reason this is horrendously hard for me. I do see the good part but apparently tend to also bring up a devaluing thought that unbalances it. E.G.--when I was trying to raise 3 kids in the marriage Ifinally left--I look back and feel guilty about howthings were--and that I stayed--and that it will affect my kids and hang over them like a cloud--and that they will end up messed up like me. When asked to ID my good points then I came up with patience--but then I found that I was also thinking I sat back all those years and was not courageous enough to do anything. When I came up with 'determined' I also came up with stubborn.It is so hard for me to describe myself as very able and someone to look up to. My mind goes blank. But I know it's there. I do well at work and people compliment me all the time. But still my mind goes blank.
What would happen if I started in EMDR with a positive thought or picture? would I (as a fear)dive away from it into the other side? And would that be OK?
Have appt in Sept with new psychiatrist. Will ask about Remeron, weight gain etc. I am OK during the day when busy. But if I am around food especially a night I find that the feeling that I've had enough--that was always there before Remeron--is non-existant! The gain has leveled off but won't go down no matter how much I exercise (walking 3 times week for 5-7 miles at this point and smaller distances in between) and even though I only eat a 1/2 container of yogurt with wheat germ, bran, soy nuggets stirred in for BF and can of slim fast for lunch. UNtil 6PM, other than water that's all I have had since spring. Sleep is good as long as I have NO caffeine, chocolate, alcohol at all--and take a small amount of estradiol for hot flashes. But I still have to push myself to do things and find that outside work and one friend I retreat to my apartment by myself. The dark times have been very limited in the last few months. But I just don't pop up above that flat line. I would like to, but it doesn't seem to happen often. And, I still often move into a sort of agitated, irritable state--usually triggered by not feeling in control, or prepared. And it is hard to get out of it.
I also have all my vacation time saved up since Istarted work last August. I don't seem to be able to vacation. It was denied to me for the last few decades and I am having trouble with it. I am saving it up for something wonderful or special and it's not coming up. And I don't want to "waste it" on just staying home or by myself. Oh well.
I do think EMDR is helping. Like you once said, the changes are easier to see in hindsight. Wish this therapist was not going. Will see her till Sept when I go to new MD and she wants to transition me to a therapist there she thinks would be good for me.
Hope you are still lurking here.
Do you notice any diff in me through my postings since EMDR?
Dotty
Posted by Susan on July 16, 1999, at 23:10:40
In reply to Re: eye movement desensitization-? for Toby, posted by DL on July 16, 1999, at 9:04:43
Dotty,
I notice a difference! I have been checking every night wondering how you are and was so glad to read your post. My filing cabinet accidently got deleted along with your e-mail address. I am the Susan who wrote to you about 6 months ago. I am doing better also. I am guessing that Toby will say positive is a good direction to try with EMDR.
I had that uncontrollable hunger with Remeron when I tried it and did not feel like myself. It sure made me sympathetic toward those who can't control their appetite. Effexor works better for me. But Remeron gave the best sleep! Good night.
Posted by Toby on July 22, 1999, at 9:10:04
In reply to Re: eye movement desensitization-? for Toby, posted by DL on July 16, 1999, at 9:04:43
Accidentally submitted prematurely, so there is another blank message before this. Sorry.
To Elizabeth - There are now so many research papers on EMDR that it is difficult to list them all. For the best listing, go to the EMDR website, www.emdr.com, and see that fairly up to date list. Sadly, most of the review papers indicate that EMDR doesn't work. However, when the review papers are closely looked at, it is revealed that the reviewers are looking only at research papers done by researchers who aren't trained in EMDR and aren't really even doing proper EMDR. But those papers get lots of press and get quoted so they become "mythical fact."
When Francine did her early work, she was just a PhD candidate, but now she is fully credentialed and the folks that work with her are well credentialed and respected. As for the notion that it should be rejected because there is no theoretical basis for why it works: I rarely scoff, but I scoff at the idea that it should be rejected because we don't know how it works. After all, do we know why cognitive-behavioral therapy works for OCD or panic or depression as well as medications do? No. But we still use them. And double-blind studies of any talk therapy is nearly impossible to do, yet we accept many different types and focuses of therapy. What of hypnosis? Do we know how it works in the brain or why? But I digress. There actually is a theory as to how and why EMDR works. EMDR is based on REM of sleep which we know are involved in memory and learning. It appears that the bilateral stimulation of the brain (both the emotional and logical sides) during sleep helps process daily events, worries, fears, etc (hence we get daily residua incorporated into dreams, Freudian interpretations of snakes chasing us, repeated nightmares of recent trauma that fade over time, etc). Bilateral stimulation of the brain during conscious awareness stimulates the brain to make rapid associations between current events, past events, emotions, and deeply held convictions (cognitions) about each of those events and emotions that appear to perpetuate our self image and subsequent life decisions. Just as in regular talk therapy where the goal is to get the person to make those associations through repeatedly recalling to them their childhood and reinterpreting various events in their lives so that they can see where they got the idea that they were helpless, useless, in danger, or whatever, EMDR does this so quickly by virtue of the fact that the bilateral stimulation occurs rapidly and the various associations are called up quickly. My own personal theory about why the results seem to last is that once a proper association is made, the brain can't return to the old association because it doesn't make sense anymore and will reject it (and the personal theory is the analogy to having someone hum part of a song that you don't like, but then you can't get the song out of your head and there you go humming the song for the rest of the day. The brain just sucks up those kinds of associations). Anyway, I know my analogy is lame, but there it is; please don't associate it with real researchers who even now are doing work with PET scans to test the areas of the brain that are stimulated during EMDR and what structural and physiologic changes occur during and after EMDR and what changes are long lasting.
As for the wide variety of things it seems to work for that don't seem to be trauma associated; again, I think it is the fact that early on EMDR was used only for trauma and it got the reputation for being the trauma treatment and nobody looked at it as being for anything else. However, therapists got curious and started saying, "well, maybe it might work for this or that" if the problem was even remotely related to trauma or perhaps had some of the characteristics that respond well to EMDR such as panic, OCD, eating disorders, performance anxiety, pain, etc. Anything that would produce a negative thought about oneself and that one could get a distressing picture about. These elements form the basis of what responds to most therapies and EMDR is no different. Change the cognitions, change the physical/emotional response to the picture and the cognitions, and the problem diminishes, if not vanishes. I fully understand why people are skeptical of the fast action, as I was when I first heard about it ("what a great scam" I thought), but as I said above, there appears to be a real reason why it is fast. The rate of "fast" appears to be different for different people, and may have something to do with how long they've been carrying the problem around, how willing they are to give it up, how many positive resources they have to replace the bad stuff with, how long ago the trauma occurred, and other physiological stuff in the brain itself. For example, I have used EMDR for many people who have had really bad car accidents, where people died or were maimed for life, and the quickest recovery time was 17 minutes from first eye movement to last, and the longest was 8 sessions, with the usual recovery time being 1 to 2 sessions (1 1/2 to 2 hours long each). Now, why did the one person recover in only 17 minutes? I don't know. That's been 3 years ago and I see her from time to time because she went from being unemployed because she could not drive anymore and could hardly stand to be in a car with someone else driving and taking 40 mg Valium per day, to going back to school and becoming a social worker, driving everywhere; so I know the effects have lasted. But perhaps she had more resources to draw on, or she was smarter and could see the proper associations more quickly or her brain just needed a push. I don't know. The one who took 8 sessions did have more traumas in her life and she jumped from one to the other and had a hard time making a connection to being safe, but once she resolved some of the other traumas, she moved pretty quickly to resolving the car accident and feeling safe so that she, too, could start driving again and living her life.
Therapists in the Boston area who do EMDR include Carol Hartman on Hillis Rd, Bessel van der Kolk on Braddock Park (he's a well-respected board certified psychiatrist who specializes in PTSD and DID), in Brookline there's Merry Arnold on Garrison Rd, Dennis Balcom on Harvard Street, Nancy Cetlin on Pnd Ave, Martha Guastella on Kent Street and Karen Peterson on Addington Rd, in Cambridge there's Janina Fisher on Massachusetts Ave, Patti Levin on Concord Ave, Zonda Mercer on Cogswell Ave, Devin Ryder at Harvard, William Simpson on Broadway, Pat thatcher on Dudley St.
Now, to Dottie,
I can tell a difference in your writing. You are more directed, self-assured. You've got less "I feel bad, always have, always will" feeling and more "I felt bad, still do sometimes, don't have to always" feeling to your writing. This is HEALTHY. This is the way so-called "normal" people cope with life and feelings. If you read all the stuff above, i want to make another analogy for you (I probably need to make less analogies, but that's just me). People who have strong resources most of their lives and then get a big trauma, may have a very difficult time recovering if they decide that every truism they ever knew is wrong as a result of this bad thing that has happened to them. if they go into therapy, EMDR or otherwise, and begin to utilize their strengths again and allow themselves to see the paradoxes of life, that good exists side by side with bad, black with white, etc, then they can crawl out of the pit they are in and stand on top again. But, although the pit felt really deep to them, reltvely speaking they weren't all that deep, they hd just never been in the pit before so they didn't know how to judge its depth. Now, a person who has been trampled on since childhood and who doesn't have much in the way of positive resources is in the pit too, but much lower down and then life comes along and throws in some rocks on their head just for good measure. So the person begins to duck and then finally never raises their head at all to avoid the rocks. So they never know how deep the pit is or how to get out of it. When they go into therapy, they too can get out of the pit, but it takes longer because they have farther to go and more rocks to dodge. Plus they need to acquire some positive resources in order to complete the journey (like you would need food and water and warmth and possibly a companion to complete a real journey). That is the basis for doing the Positive EMDR sessions. These help you access good parts of you, remember positive influences from your life, and provide something to fill the hole left by the bad stuff that has resolved. it is common for troubling issues to arise during a positive session because your brain doesn't know how to incorporate the good stuff since it has so many conflicting views from the past. When the troubling things arise, that is good because it lets you know there is a connection there that has kept you from feeling the positive stuff all this time. You just go with whatever comes up and resolve those issues and then the therapist will help you return to the positive thing you are trying to install and see if it makes more sense now. Some people visualize people who have the qualities they want and then visualize them touching their hand and the positive quality flowing into them. But you and your therapist will search out which technique works best for you.Take care.
Posted by DL on July 22, 1999, at 20:10:22
In reply to Re: I notice a difference, posted by Susan on July 16, 1999, at 23:10:40
> Dotty,
> I notice a difference! I have been checking every night wondering how you are and was so glad to read your post.Hi Susan!
Thanks for caring!! It's so nice to know someone is out there thinking of me. I have to keep reminding myself that it's only been a little over 6 mos since my divorce and moving out on my own. I think I expected I would suddenly be all set as soon as I broke that abusive connection. But, as Toby said in his post today, I guess it is sort of a deep hole I am climbing out of-- I am doing well at work. Job situation is much better since director was replaced about a month ago. But, I still have a ways to go. the EMDR is helping. ANd the therapist is excellent. I am so sorry she is moving.
> I had that uncontrollable hunger with Remeron when I tried it and did not feel like myself. It sure made me sympathetic toward those who can't control their appetite. Effexor works better for me. But Remeron gave the best sleep!I tried Effexor and did not sleep for the week I was on it. I felt like I was a bundle of nerves and had to come down off it with klonopin. Wish one with less weight problems would work for me. I see a new Doc in Sept and i will have him review meds.
Thanks for checking in. dglavoie@ttlc.net
Posted by kate on July 22, 1999, at 22:41:34
In reply to Re: I notice a difference, posted by DL on July 22, 1999, at 20:10:22
Toby--
thank you for taking time to write your posts.
I've learned alot from them,even your analogies, and will save some to read again later.
Do you know of a good shrink using EDMR (PTSD,depression,DID) in the DC area?
thanks-kate
Posted by Elizabeth on July 22, 1999, at 23:18:27
In reply to Re: EMDR - for DL and Elizabeth, posted by Toby on July 22, 1999, at 9:10:04
Toby,
Perhaps I did not make myself clear. I do not need to see *all* the studies of EMDR; I can do a Medline search if I want that. I wanted a pointer to perhaps three of them that you consider to be among the better-designed and -executed.
One criticism I've heard and read is that EMDR is just exposure therapy ("DR") wearing a funny hat; i.e., that they eye movements don't have any specific effect. This is based on dismantling studies that compared cognitive-behavior therapies with EMDR; at best, EMDR equalled the other therapy.
Has any of EMDR's proponents, presumably well-trained in the procedure, attempted a dismantling study?
I'd like to know, as well, how one decides by reading a study whether or not EMDR was "done right" in that study - other than that the researchers studied EMDR without the aid of Dr. Shapiro and colleagues? That is, what leads you to the conclusion that they did it wrong?
It's an interesting hypothesis you offer about an association between EMDR and REM sleep. Perhaps I will ask one of my teachers about this (they run a sleep lab at Mass. Mental Health Center and have done quite a bit of research on sleep). To tell you the truth, though, it sounds like hand waving. My understanding of current thought on the subject is that rapid eye movements are not what drives REM/desynchronized sleep, but rather are a byproduct of it, so that forcing eye movements that mimick those of REM sleep will not induce a state of "waking REM." Have there ever been any polysomnographic studies of EMDR? If what you are claiming were true, then such studies would show some rather extraordinary things that would not be found with ordinary desensitization therapy.
As for dreaming and associative memory, two of the main things that are hypothesized (and not without good reason) to occur during REM sleep are (1) episodic memories are incorporated into a "network" of associative memories; and (2) forgetting (taking out the garbage, as it were) takes place. Regardless of self-image, the predominant emotions in REM sleep dreams are anxious ones, with little depressive or shameful feeling.
Posttraumatic dreams, incidentally, are not like normal REM sleep dreams, perhaps because of a (dare I say it?) chemical imbalance, namely in the interaction between norepinephrine and acetylcholine. As a result, you get nonbizarre dreams that replay the memory verbatim rather than incorporating it with other memories in unpredicted ways.
It should be noted that NREM/synchronized sleep is also apparently required for learning to take place.
The question in regard to Francine Shapiro's credentials had to do with the place where she did her doctoral work, and whether it was credible or not, as I recall.
I think perhaps the problem people have with EMDR not having a theoretical basis is that they are not convinced that it works, practically speaking, either. CBT is pretty much common sense, while psychoanalytic psychotherapy is subject to many of the same criticisms as EMDR is.
I doubt it bothers people that EMDR is being claimed useful for non-trauma-related disorders in particular; rather, it's that it's being claimed useful for disorders that don't respond to "DR," though EMDR has not been proven to be any more effective than "DR."
Thank you for the list of EMDR therapists in Boston. I've never heard of any of them, but perhaps someone else I know has.
Posted by Dr. Bob on July 24, 1999, at 1:16:29
In reply to Re: EMDR and sleep, posted by Elizabeth on July 22, 1999, at 23:18:27
> two of the main things that are hypothesized (and not without good reason) to occur during REM sleep are (1) episodic memories are incorporated into a "network" of associative memories; and (2) forgetting (taking out the garbage, as it were) takes place.
I have my own hypothesis about REM sleep, which I suppose could relate to both of the above. I think of it as defragmenting your brain.
Bob
Posted by DL on July 24, 1999, at 23:24:39
In reply to Re: EMDR - for DL and Elizabeth, posted by Toby on July 22, 1999, at 9:10:04
> Now, to Dottie,
> I can tell a difference in your writing. You are more directed, self-assuredHey, thanks!! It's coming up on a year from when I first posted here and you answered!!!!! During that time I found the courage to end my 20 year marriage, started work in a new profession, used your info to get my MD to try Remeron (which allowed me to sleep finally and decreased my anx level), changed to a new therapist you recommended (who is GREAT!!!) and switched MD's (first appt with new psyc doc is Sept)--I also moved to my own place. It's good for me to look at this. The therapist has me keeping a journal of the positive events and personal attributes. It is hard for me but I am working at it! I wanted to thank you for all your help. I'm sure I asked a thousand bothersome questions. Last Aug I was at a low point and not sleeping, even with the klonopin. I am in a much better place now in many ways!!! I look forward to the therapy sessions even though it is hard work--I finally feel that I am chugging up the hill (like the Little Engine that Could--here I date myself!!) I am struggling with the prospect of separation anx--when the therapist leaves. She wants to transition me in Sept, although she will be around until Dec. She will be back and forth from out west where her family has relocated--because she is teaching at the U of NH for the Fall sememster. I want to clutch onto her and keep her here--but of course I can't. I don't think I can find another perfect match like this. What ever you did to find her, it was like a gift to me.
The EMDR does kick up a lot of "stuff". I do get a little nervous still when I know there will be a session. I always have the feeling that something terrible I have not looked at in a long time will come up again--or on the other end that I will go blank. It surprises me that I can let go of control in order to do EMDR. One time about 20 years ago, an MD I went to when I was crazy with PPD tried to teach me self-hypnosis in one 15 min session. I tried to follow all the directions but nothing happened. I sort of thought the same thing would happen with EMDR, but I launched right into it. I am so thoroughly visual that I can bring up pictures that are so sharp.
Last time I asked the therapist what kinds of things she writes down about me. She is great. She read one sessions note from when I first came. It described me as an observation but then gave a very clear and insightful picture of our session. Then I asked what the records from the Mental Health Center were like. She read 2 to me. They mostly had a few sentences of facts i.e. "patient is going to mediation for divorce, complains of continuing difficulties with sleep, continues on klonopin .25, continues to see therapist." I am glad I decided to change.
In Sept I will see the new psy doc (Dr. George Hilton). I will ask him to review medication and side effects (e.g. weight gain, and fluid retention with edema in legs and ankles etc.) and to assess whether I should stay on Remeron [one year in end of Sept]. I would also be curious to see thyroid tests again. Remember I had them done and posted results-which were all right at the bottom of the "normal" range? I have not had any blood tests of any kind in 2 years. If I am 54,and on a tiny dose of hormone replacement and Remeron, what tests would you recommend? I also should make an appt with a regular MD for check up.
Any suggestions of other things I should ask about with the new psy doc?
>>>>People who have strong resources most of their lives and then get a big trauma, may have a very difficult time recovering if they decide that every truism they ever knew is wrong as a result of this bad thing that has happened to them. if they go into therapy, EMDR or otherwise, and begin to utilize their strengths again and allow themselves to see the paradoxes of life, that good exists side by side with bad, black with white, etc, then they can crawl out of the pit they are in and stand on top again. But, although the pit felt really deep to them, reltvely speaking they weren't all that deep, they hd just never been in the pit before so they didn't know how to judge its depth. Now, a person who has been trampled on since childhood and who doesn't have much in the way of positive resources is in the pit too, but much lower down and then life comes along and throws in some rocks on their head just for good measure. So the person begins to duck and then finally never raises their head at all to avoid the rocks. So they never know how deep the pit is or how to get out of it. When they go into therapy, they too can get out of the pit, but it takes longer because they have farther to go and more rocks to dodge. Plus they need to acquire some positive resources in order to complete the journey (like you would need food and water and warmth and possibly a companion to complete a real journey).
Because I am so visual, the metaphors are great!! I do the same thing when I try to explain things to people. This one is great!
>>>That is the basis for doing the Positive EMDR sessions. These help you access good parts of you, remember positive influences from your life, and provide something to fill the hole left by the bad stuff that has resolved.Next EMDR session is first Thurs in Aug since therapist is gone next week. I will see how positive session goes!!
QUESTION: there have been a number of postings on SAM-e here. I also read some of the new book out on it, done by some respected people. It is expensive, but Wal Mart has it for $19 for 20. The authors who treat people with it all the time stated that they use it frequently to augment other AD's --they recommend 400mg daily and say it rarely has side effects. Have you any experience with it or any wisdom on the subject? I was wondering if it might help me?
Guess what? I planted a garden (12x12ft) at this apartment and I have green beans, snowpeas, scallions, cherry tomatoes, dill, parsley, lettuce and already a green pepper, eggplant and some cukes!!!!! I am now glad I forced myself to do it!
Keep checking in. Thanks
Dotty
> Take care.
>
Posted by DL on July 26, 1999, at 20:33:24
In reply to Re: EMDR - for DL and Elizabeth, posted by DL on July 24, 1999, at 23:24:39
Remeron continues to let me sleep unless I take in caffeine, alcohol,or any stimulant. It also reduces anx level. I do not feel drowsy on it. But life is still flat and I hate the weight gain (has leveled off but I can't get rid of the 25 lbs). I cannot take SSRI's. They increase anxiety and return to sleep probs. Anyone out there have any suggestions?
Posted by Toby on July 27, 1999, at 9:15:57
In reply to Re: EMDR - for DL and Elizabeth, posted by DL on July 24, 1999, at 23:24:39
I don't have any experience with SAMe, mostly because it is too expensive for my patients, so nobody can try it. I haven't seen the research papers on it, although through the grapevine I hear it is good in one paper, not good in another. I asked around and no one in my area has any patients on it, either (again, cost).
When you go for you check up, I wouldn't have any extra labs I would recommend other than the usual blood count, liver profile, thyroid panel, cholesterol, and things like that that are usually done. However, based on your exam, your doc may order other things as he sees fit. I can't recall off the top of my head if they routinely do hormone levels for someone on replacement hormones. Maybe Dr. Bob knows.
Cheers to you for your garden!!! Nothing like a vine fresh tomato!!
Posted by Toby on July 27, 1999, at 12:18:39
In reply to Toby, posted by kate on July 22, 1999, at 22:41:34
Re: Kate's question about therapists in the DC area using EMDR, I find five.
JeanMarie Amiri, PhD on 42nd street (202-296-8488), Mary Froning, PsyD same street and phone, both specializing in Dissociative Disorders; Jeanette Paroly, PhD on 35th street (202-237-2223) specializing in relationship issues and couple counseling; Frederic Solomon, MD on Connecticut Ave (202-363-4204) specializing in PTSD and Anxiety Disordrs and Board certified in adult and child psychiatry; and Mary Lee Stein, MSW on Connecticut Ave (not in practice with Dr. Solomon) (202-332-0285) Specializing in PTSD and Anxiety Disorders.
Posted by Toby on July 27, 1999, at 13:02:01
In reply to Re: EMDR and sleep, posted by Elizabeth on July 22, 1999, at 23:18:27
> Perhaps I did not make myself clear. I do not need to see *all* the studies of EMDR; I can do a Medline search if I want that. I wanted a pointer to perhaps three of them that you consider to be among the better-designed and -executed.
There are actually 13 controlled trials using EMDR for PTSD, whereas there are only 6 other controlled trials using other forms of therapy (excluding medications) in all the literature. The three best would probably be these: 1) Freund, Ironson and Williams (1998) which compared EMDR and prolonged imaginal exposure therapy. Both showed positive effects. The drop-out rate was less in the EMDR group. Further, EMDR proved more efficient: 7 out of 9 clients were successfull treated in the 3 active sessions of EMDR versus 2 out of 7 for prolonged exposure. 2) Vaughan, Armstron, et al (1994) which studies 36 subjects with PTSD randomly assigned to treatments of imaginal exposure, applied muscle relaxation, or EMDR. Treatment consisted of four sessions, with 60 and 40 minutes of additional daily homework over a 2 to 3 week period for the image exposure and muscle relaxation groups, respectively, and no additional homework for the EMDR group. All treatments led to significant decreases in PTSD symptoms for subjects in the treatment groups as compared to those on a waiting list, with a greater reduction in the EMDR group, particularly with respect to intrusive symptoms. 3) Rothbaum (1997) which studied single trauma rape victims and found that after three EMDR treatment sessions, 90 percent no longer met full criteria for PTSD.
> One criticism I've heard and read is that EMDR is just exposure therapy ("DR") wearing a funny hat; i.e., that they eye movements don't have any specific effect. This is based on dismantling studies that compared cognitive-behavior therapies with EMDR; at best, EMDR equalled the other therapy.The Meta-analysis study published by van Etten and Taylor (1997) showed that EMDR is equally effective to behavior therapy, although EMDR takes significantly less time to achieve results. For example, controlled studies of exposure therapies with single trauma victims take 25-50 hours of combined treatment and expusre (Foa et al, 1991; Richards, Lovell and Marks, 1994), while EMDR takes three ninety minute sessions to eliminate 84-100 percent of the diagnoses (Marcus, Marquis and Sakai, 1997; Scheck, Schaeffer and Gillette, 1997; Wilson, Becker and Tinker, 1995). The unfortunate aspect of the meta-analysis is that it included EMDR studies conducted by researcher who had not been trained or who reported negative fidelity checks (how well the researcher performed the method), along with the studies by competent researchers. Even with this drawback, however, EMDR was termed equally efficacious.
> I'd like to know, as well, how one decides by reading a study whether or not EMDR was "done right" in that study - other than that the researchers studied EMDR without the aid of Dr. Shapiro and colleagues? That is, what leads you to the conclusion that they did it wrong?Indeed, EMDR is not just "hand waving," it is a series of 8 steps, an entire protocol that is addressed to the PTSD and now there are even specific protocols for specific problems such as substance abuse, phobias, OCD and eating disorders. These more complicated disorders require more complex treatment protocols. It is NOT just the eye movements, but it does seem that the eye movements are what speeds up the effects. I say this because the specific protocols I mentioned incorporate (usually) several different techniques borrowed from CBT, Neuro Linguistic Therapy, psychoanalysis, supportive therapy, dialectical behavioral therpy, educational therapy, etc. And those therpies do work, obviously, but adding the eye movements makes it go faster. But back to your question: The researchers that I disparage for "doing it wrong" were not trained in EMDR, they didn't follow a protocol, we don't know how long they "waved their hand" or if they talked to the patient during the sessions or exactly what all they did do. So, basically, they weren't doing EMDR anymore than Dear Abby is doing therapy.
> It's an interesting hypothesis you offer about an association between EMDR and REM sleep. Perhaps I will ask one of my teachers about this (they run a sleep lab at Mass. Mental Health Center and have done quite a bit of research on sleep). To tell you the truth, though, it sounds like hand waving. My understanding of current thought on the subject is that rapid eye movements are not what drives REM/desynchronized sleep, but rather are a byproduct of it, so that forcing eye movements that mimick those of REM sleep will not induce a state of "waking REM." Have there ever been any polysomnographic studies of EMDR? If what you are claiming were true, then such studies would show some rather extraordinary things that would not be found with ordinary desensitization therapy.Am not aware of any PSG studies published, though I don't know if any are being done now. I am aware that some studies are being conducted using PET and SPECT to study brain changes before and after EMDR and I think also in a controlled study comparing exposure to EMDR using PET scans. It may not be feasible to study EMDR using PSG due to movement artifact, but not sure.
> As for dreaming and associative memory, two of the main things that are hypothesized (and not without good reason) to occur during REM sleep are (1) episodic memories are incorporated into a "network" of associative memories; and (2) forgetting (taking out the garbage, as it were) takes place. Regardless of self-image, the predominant emotions in REM sleep dreams are anxious ones, with little depressive or shameful feeling.Exactly how it is hypothesized that EMDR works.
> Posttraumatic dreams, incidentally, are not like normal REM sleep dreams, perhaps because of a (dare I say it?) chemical imbalance, namely in the interaction between norepinephrine and acetylcholine. As a result, you get nonbizarre dreams that replay the memory verbatim rather than incorporating it with other memories in unpredicted ways.
But is it a chemical imbalance that causes the nightmares or the vulnerability to PTSD or is it the degree of trauma that inhibits resolution fo the event and then leads to the chemical imbalance? One small correction is that PTSD memories are not consistently verbatim forever and ever but do tend to incorporate other events into them and also insinuate themselves into other types of dreams.
> It should be noted that NREM/synchronized sleep is also apparently required for learning to take place.No argument here.
> I think perhaps the problem people have with EMDR not having a theoretical basis is that they are not convinced that it works, practically speaking, either. CBT is pretty much common sense, while psychoanalytic psychotherapy is subject to many of the same criticisms as EMDR is.
I think the problem people have with not believing the EMDR works on a practical level is that they haven't seen any patients who have had EMDR. And I don't think seeing just one patient is such a mind-changer because after all, that could just be a fluke of nature, or an easily suggestible person. But see several people and you begin to say, hmmmmmmm. Then experience it on yourself and you say, whoa, I'm not that suggestible, I'm a skeptic of this whole process, I'm actively resisting this, where did THIS come from? Then you compare your response rate of the patients with PTSD going out the door smiling and sleeping for the first time in months or years with the patients you work with for months on relaxation therapy and CBT and exposure therapy who feel better and don't worry so much but in whom a relapse and flashbacks can still be triggered with the right stimulus and you say, OK, I don't know exactly how it works, but I don't know how relaxation or CBT or hypnosis or exposure works either, but the EMDR patients are better faster, to a greater degree and with longer lasting and more generalized results. Which treatment am I going to use? Hmmmmmmm.
> I doubt it bothers people that EMDR is being claimed useful for non-trauma-related disorders in particular; rather, it's that it's being claimed useful for disorders that don't respond to "DR," though EMDR has not been proven to be any more effective than "DR."I don't know which disorders those might be that don't respond to "DR" but that EMDR is claiming efficacy for.
Posted by carrot on September 11, 1999, at 1:54:06
In reply to Re: EMDR - for DL and Elizabeth, posted by Toby on July 22, 1999, at 9:10:04
>I have a couple of questions about EMDR. I was seeing a generally awful psychiatrist (he mixed me up with other patients nearly every session and only realized it after 45 minutes)...but, he does EMDR, and regardless of how I feel about his effectiveness in psychotherapy, I'm interested in having some sessions.
I have had panic attacks and generalized anxiety for 20 years (I'm 32). My symptoms are similar to PTSD, but I don't have a particular trauma (that I'm aware of at least) which precipitated my overactive fight-or-flight response, terror, dread, and existential angst.
Given this scenario, how would I approach EMDR with this Dr? Do I need an episode, trauma or `picture' to focus on for the EMDR to be effective? In other words, if my anxiety is generalized, and I for example focus on fear of driving, will my generalized anxiety be affected, or just anxiety related to driving? How would you approach doing EMDR with this scenario...or is it not effective with generalized anxiety?
Thanks. Carrot
Accidentally submitted prematurely, so there is another blank message before this. Sorry.
>
> To Elizabeth - There are now so many research papers on EMDR that it is difficult to list them all. For the best listing, go to the EMDR website, www.emdr.com, and see that fairly up to date list. Sadly, most of the review papers indicate that EMDR doesn't work. However, when the review papers are closely looked at, it is revealed that the reviewers are looking only at research papers done by researchers who aren't trained in EMDR and aren't really even doing proper EMDR. But those papers get lots of press and get quoted so they become "mythical fact."
>
> When Francine did her early work, she was just a PhD candidate, but now she is fully credentialed and the folks that work with her are well credentialed and respected. As for the notion that it should be rejected because there is no theoretical basis for why it works: I rarely scoff, but I scoff at the idea that it should be rejected because we don't know how it works. After all, do we know why cognitive-behavioral therapy works for OCD or panic or depression as well as medications do? No. But we still use them. And double-blind studies of any talk therapy is nearly impossible to do, yet we accept many different types and focuses of therapy. What of hypnosis? Do we know how it works in the brain or why? But I digress. There actually is a theory as to how and why EMDR works. EMDR is based on REM of sleep which we know are involved in memory and learning. It appears that the bilateral stimulation of the brain (both the emotional and logical sides) during sleep helps process daily events, worries, fears, etc (hence we get daily residua incorporated into dreams, Freudian interpretations of snakes chasing us, repeated nightmares of recent trauma that fade over time, etc). Bilateral stimulation of the brain during conscious awareness stimulates the brain to make rapid associations between current events, past events, emotions, and deeply held convictions (cognitions) about each of those events and emotions that appear to perpetuate our self image and subsequent life decisions. Just as in regular talk therapy where the goal is to get the person to make those associations through repeatedly recalling to them their childhood and reinterpreting various events in their lives so that they can see where they got the idea that they were helpless, useless, in danger, or whatever, EMDR does this so quickly by virtue of the fact that the bilateral stimulation occurs rapidly and the various associations are called up quickly. My own personal theory about why the results seem to last is that once a proper association is made, the brain can't return to the old association because it doesn't make sense anymore and will reject it (and the personal theory is the analogy to having someone hum part of a song that you don't like, but then you can't get the song out of your head and there you go humming the song for the rest of the day. The brain just sucks up those kinds of associations). Anyway, I know my analogy is lame, but there it is; please don't associate it with real researchers who even now are doing work with PET scans to test the areas of the brain that are stimulated during EMDR and what structural and physiologic changes occur during and after EMDR and what changes are long lasting.
>
> As for the wide variety of things it seems to work for that don't seem to be trauma associated; again, I think it is the fact that early on EMDR was used only for trauma and it got the reputation for being the trauma treatment and nobody looked at it as being for anything else. However, therapists got curious and started saying, "well, maybe it might work for this or that" if the problem was even remotely related to trauma or perhaps had some of the characteristics that respond well to EMDR such as panic, OCD, eating disorders, performance anxiety, pain, etc. Anything that would produce a negative thought about oneself and that one could get a distressing picture about. These elements form the basis of what responds to most therapies and EMDR is no different. Change the cognitions, change the physical/emotional response to the picture and the cognitions, and the problem diminishes, if not vanishes. I fully understand why people are skeptical of the fast action, as I was when I first heard about it ("what a great scam" I thought), but as I said above, there appears to be a real reason why it is fast. The rate of "fast" appears to be different for different people, and may have something to do with how long they've been carrying the problem around, how willing they are to give it up, how many positive resources they have to replace the bad stuff with, how long ago the trauma occurred, and other physiological stuff in the brain itself. For example, I have used EMDR for many people who have had really bad car accidents, where people died or were maimed for life, and the quickest recovery time was 17 minutes from first eye movement to last, and the longest was 8 sessions, with the usual recovery time being 1 to 2 sessions (1 1/2 to 2 hours long each). Now, why did the one person recover in only 17 minutes? I don't know. That's been 3 years ago and I see her from time to time because she went from being unemployed because she could not drive anymore and could hardly stand to be in a car with someone else driving and taking 40 mg Valium per day, to going back to school and becoming a social worker, driving everywhere; so I know the effects have lasted. But perhaps she had more resources to draw on, or she was smarter and could see the proper associations more quickly or her brain just needed a push. I don't know. The one who took 8 sessions did have more traumas in her life and she jumped from one to the other and had a hard time making a connection to being safe, but once she resolved some of the other traumas, she moved pretty quickly to resolving the car accident and feeling safe so that she, too, could start driving again and living her life.
>
> Therapists in the Boston area who do EMDR include Carol Hartman on Hillis Rd, Bessel van der Kolk on Braddock Park (he's a well-respected board certified psychiatrist who specializes in PTSD and DID), in Brookline there's Merry Arnold on Garrison Rd, Dennis Balcom on Harvard Street, Nancy Cetlin on Pnd Ave, Martha Guastella on Kent Street and Karen Peterson on Addington Rd, in Cambridge there's Janina Fisher on Massachusetts Ave, Patti Levin on Concord Ave, Zonda Mercer on Cogswell Ave, Devin Ryder at Harvard, William Simpson on Broadway, Pat thatcher on Dudley St.
>
> Now, to Dottie,
> I can tell a difference in your writing. You are more directed, self-assured. You've got less "I feel bad, always have, always will" feeling and more "I felt bad, still do sometimes, don't have to always" feeling to your writing. This is HEALTHY. This is the way so-called "normal" people cope with life and feelings. If you read all the stuff above, i want to make another analogy for you (I probably need to make less analogies, but that's just me). People who have strong resources most of their lives and then get a big trauma, may have a very difficult time recovering if they decide that every truism they ever knew is wrong as a result of this bad thing that has happened to them. if they go into therapy, EMDR or otherwise, and begin to utilize their strengths again and allow themselves to see the paradoxes of life, that good exists side by side with bad, black with white, etc, then they can crawl out of the pit they are in and stand on top again. But, although the pit felt really deep to them, reltvely speaking they weren't all that deep, they hd just never been in the pit before so they didn't know how to judge its depth. Now, a person who has been trampled on since childhood and who doesn't have much in the way of positive resources is in the pit too, but much lower down and then life comes along and throws in some rocks on their head just for good measure. So the person begins to duck and then finally never raises their head at all to avoid the rocks. So they never know how deep the pit is or how to get out of it. When they go into therapy, they too can get out of the pit, but it takes longer because they have farther to go and more rocks to dodge. Plus they need to acquire some positive resources in order to complete the journey (like you would need food and water and warmth and possibly a companion to complete a real journey). That is the basis for doing the Positive EMDR sessions. These help you access good parts of you, remember positive influences from your life, and provide something to fill the hole left by the bad stuff that has resolved. it is common for troubling issues to arise during a positive session because your brain doesn't know how to incorporate the good stuff since it has so many conflicting views from the past. When the troubling things arise, that is good because it lets you know there is a connection there that has kept you from feeling the positive stuff all this time. You just go with whatever comes up and resolve those issues and then the therapist will help you return to the positive thing you are trying to install and see if it makes more sense now. Some people visualize people who have the qualities they want and then visualize them touching their hand and the positive quality flowing into them. But you and your therapist will search out which technique works best for you.
>
> Take care.
>
This is the end of the thread.
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