Talk:Eye movement desensitization and reprocessing

Bessel van der Kolk

This edit added the text "The Dutch-born researcher and psychologist Bessel van der Kolk, author of The Body Keeps the Score, has endorsed EMDR as one of the most effective ways to treat PTSD symptoms. However, an editor reverted it with the edit summary "undue lay sources".

Chapter 15 of Van der Kolk's book is on EMDR. On page 369 he summarizes the reasons why he he finds it intriguing and of value: it's action is rapid, people unwilling or unable to talk about their traumatic experience can still get relief, and this is useful because those seeking help with trauma may find it difficult or impossible to form a trusting relationship with a therapist.

Bessel van der Kolk: “EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past. This seems to help them put the traumatic experience into a larger context or perspective. People may be able to heal from trauma without talking about it. EMDR enables them to observe their experiences in a new way, without verbal give-and-take with another person. EMDR can help even if the person and the therapist do not have a trusting relationship. This was particularly intriguing because trauma, understandably, rarely leaves people with an open, trusting heart.”

Some have argued that CBT or standard exposure therapy (ET) is the same as EMDR, but there are key differences that can make a substantial difference to a given individual for whom both types of therapy (CBT & ET) have already failed to provide any relief for the reasons Van der Kolk recognizes. Regardless, he is a published, subject matter expert on trauma - not a "lay source". Cedar777 (talk) 22:58, 13 April 2023 (UTC)

Sources

The source cited is his lay press book (Penguin books). So yes, it is a lay press source, regardless of the author. It was not published by an academic press. It is not comparable to the academic articles and position statements written by Van Der Kolk, which we already cite in this article. — Shibbolethink ^{(♔ ♕)} 23:23, 13 April 2023 (UTC)

What P&G are you referring to that states only academic publishers are permitted as sources? Cedar777 (talk) 23:34, 13 April 2023 (UTC)

That's not what I claimed. It's simply correct to state the source is a "lay source" and also correct to say that using it as a MEDRS is not ideal, and pretty explicitly discouraged per WP:MEDASSESS.

I would also agree with the reversion that it may be UNDUE, given that it's a lay source, and especially given that we already have multiple sources which are from Van Der Kolk's organization (ISTSS) in the article. This, compared to the sources already used, is of a much lower quality.

if we are to use Van Der Kolk as a single RSOPINION, I think we should probably find a better source for him. In an academic press or expert review paper, etc. — Shibbolethink ^{(♔ ♕)} 23:37, 13 April 2023 (UTC)

On the one hand, van der Kolk is enough of a big name in trauma research that his opinion oughta be notable on its own, separate from bigger organizations that he belongs to. On the other hand, I have two quibbles: one is the one Shibbolethink noted that we ideally should get his opinion from an academic source. And the other one is that he seems to be endorsing Shapiro's original theory for why EMDR works, which doesn't really have much support in the sources otherwise. This doesn't make his opinion useless (after all, he is just as much an expert as the experts who say otherwise) but it does make him a minority position in the field, which means we should definitely attribute his opinions to him rather than citing him for bigger claims. Loki (talk) 00:23, 14 April 2023 (UTC)

Upon some basic Googling, van der Kolk has also co-written (or at least, edited?) this book by an academic publisher, which we don't currently cite. I'll try to get my hands on a copy and see if the authors mention EMDR anywhere. (I will say though, it was published in 2007 so it's a bit old for a medical source.) Loki (talk) 00:34, 14 April 2023 (UTC)

Update: Found a paper copy, and they do! Big quotes follow:

p455: EMDR, a new treatment for PTSD using rapid rhythmic eye movements, has been described by Francine Shapiro (1989, 1995). The patient is told to maintain an image of the original traumatic experience, and is encouraged to simultaneously evoke the event and associated feelings while engaging in the eye movements. Although some of the initial studies suffered from serious methodological flaws (Herbert & Mueser, 1992), a steady output of successful case reports has encouraged further investigation of EMDR. While one preliminary report by Lyde (cited by Metter & Michelson, 1993), comparing EMDR with non-eye-movement desensitization and a nondirective counseling session, suggested that EMDR was not significantly different from the controls and possibly less efficacious than having the subjects "stare at a dot on the wall," other studies are very encouraging and indicate that this new form of treatment, despite its incomprehesible technique, seems to be capable of producing powerful therapeutic effects in some patients with PTSD (Wilson et al., 1995; Vaughan et al., 1994a, 1994b).

p498: A new technique, eye movement desensitization and reprocessing (EMDR; Shapiro, 1989) is a form of exposure (desensitization) with a strong cognitive component accompanied by saccadic eye movements. Briefly, the technique involves the client's imagining a scene from the trauma, focusing on the accompanying thoughts and physiological arousal, and tracking the therapist's rapidly moving finger. The sequence is repeated until the client no longer reports anxiety, at which point the client is instructed to adopt a more positive thought while imagining the trauma and continuing the eye movements. The efficacy of EMDR is equivocal. Proponents of this treatment have interpreted the reported anxiety reduction within a treatment session as indicative of its success (e.g., Lipke & Botkin, 1993; Shapiro, 1989). However, they did not include standardized outcome measures such as PTSD symptom ratings or depression inventories, so that the efficacy of EMDR cannot be ascertained.

Two controlled studies have compared EMDR to an exposure control (eyes fixed) treatment (Boudewyns, Stwertka, Hyer, Albrecht, & Sperr, 1993; Pitman et al., 1993) and inpatient milleu treatment (Boudewyns et al., 1993). It appears that in both studies, within-session reported anxiety decreased more in the EMDR group than in the exposure control group. However, neither study detected differences between the groups on outcome as assessed by standardized self-report measures or psychophysiological reactivity to taped accounts of the trauma (Boudewyns et al., 1993). When one considers these two studies on the usefulness of EMDR, it is also important to remember that both utilized Vietnam veterans—a population that may be resistant to treatment in general.

In summary, exposure techniques have received strong support for their ability to alleviate posttraumatic suffering. [section following goes on to discuss the general lack of effectiveness of exposure techniques in Vietnam veterans; won't quote at length unless others think its relevant]

p548-549: After an initial flurry of single-case reports and open studies, a number of systematic studies of EMDR have been conducted in recent years. Positive results have been found in at least four controlled studies (Shapiro, 1989; Wilson, Covi, Foster, & Silver, 1993; Wilson, Tinker, & Becker, in press; Vaughan, Wiese, Gold, & Tarrier, 1994), equivocal results in two studies (Boudewyns, Stwertka, Hyer, Albrecht, & Speer, 1993; Pitman et al., 1996a), and negative outcomes in two studies (Jensen, 1994; Sanderson & Carpenter, 1992). The equivocal and negative studies were conducted on very chronic populations; such patients have also proven resistant to pharmacological (e.g., van der Kolk et al, 1994) and cognitive-behavioral (Pitman etal., 1996b) interventions. In the EMDR studies with positive treatment outcomes, beneficial effects have particularly been demonstrated in the frequency and intensity of intrusive recollections, such as nightmares and flashbacks (e.g., Vaughan et al., 1994; Shapiro, 1995; Wilson et al., in press).

Because The Body Keeps The Score is a more recent work, it may be worth mentioning briefly to say how van der Kolk's opinion has changed. But aside from that one note, I'd prefer mainly sourcing this, it definitely seems more rigorous to me.

Some notes:

• Van der Kolk calls EMDR an exposure therapy with strong cognitive components. He in general seems pretty unambiguous that he considers it to be a form of exposure therapy.
• He mentions its "incomprehensible technique" once, and seems to be generally optimistic for but not entirely convinced of its efficacy. If the quote from Cedar777 above is at all typical, he seems to have become more convinced on this point more recently.
• He mentions a so-far novel explanation for EMDR's lack of efficacy in some early studies, namely that Vietnam veterans in general respond worse to any kind of exposure technique. This seems to be unique to him AFAICT, so we should definitely attribute him if we mention this.

Loki (talk) 05:00, 14 April 2023 (UTC)

A book from 1996? Bon courage (talk) 05:05, 14 April 2023 (UTC)

Hmm, the most recent printing is from 2008 but you're right that this information doesn't seem to have been updated. Loki (talk) 07:19, 14 April 2023 (UTC)

Because re-prints just ... re-print. Bon courage (talk) 07:36, 14 April 2023 (UTC)

• I'd say leave it out. When we have national guidelines and MEDRS in play why add some guy's view too? especially when the sources are a bit crappy. WP:UNDUE. Bon courage (talk) 03:53, 14 April 2023 (UTC)

  We have other sources that are the opinion of a single expert author, like the Science Based Medicine source which we quote from at length, or the book by Luis Cordón who we also name when giving his opinions. Now, both of those sure are reliable sources, but their presence in the article means the opinions of individual experts are in fact relevant to the article.

  This is especially the case for van der Kolk, who's been the head of several big professional organizations and is probably the best known trauma researcher alive. His opinion isn't going to overrule the consensus of the sources or anything, of course, but it's notable enough to mention it briefly. Loki (talk) 04:33, 14 April 2023 (UTC)

  The other stuff is not for the MEDRS aspects, but for history, classification, pseudoscience and so on. Needed content. But when we have MEDRS for the biomedical aspects adding "and this person thinks so too" from a weak source is undue, especially since his view is already incorporated in the MEDRS we include. Bon courage (talk) 05:16, 14 April 2023 (UTC)

  "the opinions of individual experts" in the context of FRINGE are included to establish WP:PARITY. Van der Kolk, on the other hand, could be used as SECONDARY or maybe TERTIARY for WP:MEDRS, but those outdated quotes seems to underscore what is already in the article--that the treatment has a lot of practitioners and patients who swear by it, but rigorous results are mixed, the mechanism unclear, and it is most likely a form of exposure therapy. DolyaIskrina (talk) 17:51, 14 April 2023 (UTC)

Economic aspects

We have no information on market size, training or session fees. I added some but Cedar777‎ just reverted it all for no good reason. What is going on? Bon courage (talk) 06:54, 14 April 2023 (UTC)

Seems WP:DUE to me. And using it there does not rule out using that meta-analysis elsewhere, if done so in an appropriately weighted fashion. — Shibbolethink ^{(♔ ♕)} 11:07, 14 April 2023 (UTC)

I wouldn't use that journal for anything biomedical, but for pricing stuff it's just fine. Now: is there a source for how much sessions typically cost? Bon courage (talk) 11:11, 14 April 2023 (UTC)

Looks like POV pushing to single out those details from a source titled "Effectiveness of EMDR for decreasing symptoms of over‐arousal: A meta‐analysis". Does more than one source report on these details? The fixation on pricing doesn't do much to serve the readers . . . but it does advance a POV that implies the VA, WHO, and other WP:MEDORGs have been duped (along with any survivors of sexual assault and veterans with PTSD who have been helped by this therapy). Cedar777 (talk) 15:37, 14 April 2023 (UTC)

What silly rubbish. How does pricing imply anybody has been "duped"? Following sources is not "POV-pushing" (except perhaps in the minds of WP:PROFRINGE editors). If you want to propose a less good source for this, then let's see it! Bon courage (talk) 15:51, 14 April 2023 (UTC)

Here's my questions: do other similar articles include this information? Do sources mention these costs more for EMDR than for other psychotherapies? Is the place that changes that really the only place to get training in EMDR? What do training costs look like for other psychotherapies?

If they really are exceptional in some way, I can see the argument that they're WP:DUE. But if they aren't notably different from other psychotherapies, and articles on those therapies don't include equivalent info, including them here probably isn't WP:DUE. Loki (talk) 17:08, 14 April 2023 (UTC)

Wikipedia operates by WP:PAGs, not "what other articles do", especially low-grade articles. In any article being improved, yes, it is common for pricing to be included. And for a pseudoscience topic apt where health fraud is in play. Bon courage (talk) 17:14, 14 April 2023 (UTC)

A) There is no mention of cost in either of the lengthy articles for Dialectical behavior therapy or for Cognitive behavior therapy. B) The inclusion of pricing information in medicine articles in general has no consensus WP:MEDMOS2020. C) policy What Wikipedia is not includes, "an article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention [...] Wikipedia is not a price comparison service to be used to compare the prices of competing products, or the prices of a single product from different vendors." Cedar777 (talk) 17:34, 14 April 2023 (UTC)

That dispute was about "pharmaceutical drug prices". EMDR is not a pharmaceutical drug. Information about market size/pricing/etc, if included in high-quality sources, is due. We're not doing an EMDR 'price comparison'; just reflecting what decent sources say about EMDR pricing in general. Which is good! Bon courage (talk) 17:39, 14 April 2023 (UTC)

The argument that "it is common for pricing to be included" is not supported by the CBT or DBT article and is also generally refuted by the RFC. What is there to back up this opinion? Cedar777 (talk) 18:03, 14 April 2023 (UTC)

To repeat, we don't go by other (poor) articles. The aim (my aim anyway) is to get this one good. If you want to get back to your preferred text, other than by continually reverting, maybe try an RfC or something? Bon courage (talk) 18:09, 14 April 2023 (UTC)

The reason there is no price listed for DBT or CBT is probably that these are both much less standard than EMDR, which is basically invented and run as a business by one person (and her followers). Not a very comparable situation to DBT or CBT, and there is no Wikipedia-wide consensus on this.

More comparable articles would probably be Psychopathy Checklist, Conversion therapy, which both list some other aspects of the economics of a pseudoscientific treatment. But I cannot think of a single therapy which is truly similar to EMDR's situation with near-monopoly on "official" training by a live inventor.

I think BC is right, we would need a local RfC to determine whether this information is DUE for this page, if you wish to go against any local consensus. — Shibbolethink ^{(♔ ♕)} 21:09, 14 April 2023 (UTC)

Well, do we have sources for the near-monopoly on training?

I think that situation as a whole if it can be sourced is probably WP:DUE. We do sometimes note price on medical articles if the price itself or how it was arrived at is notable, for instance on Epi-Pen. But in general I'd be against including pricing information in a vacuum: the thing that would be giving it encyclopedic value is the context surrounding it, not the number a particular organization is charging by itself.

At least based on the first source I was able to find on a simple search it doesn't appear that the training price for EMDR is out of line with that of other forms of therapy (though this study didn't include EMDR on its list so it's not a direct comparison), which also IMO cuts against including it. Loki (talk) 23:33, 14 April 2023 (UTC)

I'm unclear why pricing info is DUE, and what encyclopedic value it has that makes it an exception to WP:NOTPRICE --Hipal (talk) 16:36, 19 April 2023 (UTC)

Consensus to add a source

Does this source:

support adding a line to the Effectiveness section saying "though some researchers maintain that EMDR's distinctive features do contribute to its effectiveness"?

I don't see any way to dispute that it does: this is a high quality WP:TERTIARY source by experts in the area. It says directly that Cuijpers and Lee's meta-analysis supports the use of the eye movements (including responding to criticism of their meta-analysis) and goes on to offer explanations for why the eye movements are effective.

However, I was reverted when trying to add it, so I'm coming to the talk page to ask about it. Loki (talk) 00:39, 16 April 2023 (UTC)

Seems a bit misleading to include a quotation and leave out a key bit

However, a meta-analysis of randomized controlled trials and laboratory studies specifically tested the additive benefit of bilateral eye movements and indicated that eye movements did produce statistically reliable clinical benefits (Lee and Cuijpers 2013). In a critique of this meta-analysis, Devilly et al. (2014) raised methodological objections to which Lee and Cuijpers (2014) replied. Several explanations have been put forward ...

I think the most this source (which was already cited) can be used for in this respect, is to restate that research into EMDR has been criticized for poor quality. Bon courage (talk) 06:04, 16 April 2023 (UTC)

Certainly that is part of the source, and I have no problem talking about that bit (but note that Lee and Cuijpers replied to the objection). But that bit doesn't cancel out the part of the source which says that at least some researchers do believe that the eye movements do something.

Alternatively and/or in addition, how about adding the NYT source where McNally says he now believes the eye movements are useful? NYT is not usually a WP:MEDRS quality source, but if they're quoting an expert in the field, I think they're usable for the direct quote. Loki (talk) 18:52, 16 April 2023 (UTC)

It kind of does "cancel it out", to the extent that mentioning one but suppressing the other is what we call WP:PROFRINGE POV-pushing. And no the NYT is not "not usually" MEDRS, it is never MEDRS. Again, POV-pushing. Stick to the best sources. Bon courage (talk) 18:59, 16 April 2023 (UTC)

So, I think you've failed to read the part where I said "I have no problem talking about that bit". I'm fine with mentioning both halves. Loki (talk) 02:09, 17 April 2023 (UTC)

We don't need to say "at least some researchers do believe that the eye movements do something" We already show that perspective with multiple statements and citations throughout the article. Over-emphasizing it like this is just raising a perspective above its merit in the literature. — Shibbolethink ^{(♔ ♕)} 16:53, 17 April 2023 (UTC)

In general, I think the editing approach which is: let's do a WP:PROFRINGE edit and skew the source, and see if anybody else notices to clean it up - is getting old very quickly. Bon courage (talk) 17:16, 17 April 2023 (UTC)

(edit conflict) Eh, y'know what, I think you've actually convinced me on this. I was going to argue for weakening the language of the previous sentence if that's what you think (i.e. "it's been criticized as a purple hat therapy because critics say its effectiveness comes entirely from the parts that are similar to exposure therapy") but looking at the sources, it seems like even many supporters of EMDR, like van der Kolk and the NHMRC, support it as a kind of exposure therapy.

There definitely are some neutral experts who think the eye movements really are effective, but it seems like that WP:MEDRS quality RSes tend to mention that one meta-analysis but don't really go further into saying that it means the eye movements definitely are effective, the way other sources are emphatic about its overall effectiveness. As such it's hard to really pin anyone down to the opinion that the eye movements work, and if we don't have sources saying a thing we can't say it.

I do think we should be clearer in splitting out "EMDR's effectiveness is probably mostly due to the exposure-like parts" from "it is therefore a purple-hat therapy (i.e. ineffective junk added to a known effective treatment)" from "it is pseudoscientific", because we have a bunch of sources that say 1 but not 2 or 3, and some that say 1 and 2 but not 3. Loki (talk) 17:17, 17 April 2023 (UTC)

"Unusually for a pseudoscience"

I notice that @Terringer and @MrOllie have been having a dispute about this line. Personally I favor removal of that line, since I think the balance of the sources very much show that EMDR as a whole is not pseudoscientific. One academic book, however reliable, doesn't override several big WP:MEDORG sources that call EMDR an evidence-based treatment for PTSD.

This is separate from whether the eye movements or Shapiro's original proposed explanation were pseudoscientific. Those may well be; at the very least the eye movements are only marginally supported by evidence at best, and Shapiro's original proposed explanation has received basically no independent support and seems to be pretty clearly debunked. While we have many sources that endorse EMDR as evidence-based, the strongest ones are mostly either agnostic as to the mechanism or explicitly endorse it as a form of exposure therapy. Loki (talk) 17:11, 4 May 2023 (UTC)

Seems well-sourced. Can't think why it should be removed. We're not going to re-run the disruptive fallacy about what-sources-don't-say again are we? Bon courage (talk) 17:13, 4 May 2023 (UTC)

We have discussed this at length multiple times. The MEDORG sources don't support the arguments you're trying to use them for. We don't need to re-litigate this again from scratch because a newbie editor made some drive-by edits without consulting the talk page. MrOllie (talk) 17:41, 4 May 2023 (UTC)

Right, the pseudoscience-in source straight-up says almost this exact phrasing. Very well supported. — Shibbolethink ^{(♔ ♕)} 17:43, 4 May 2023 (UTC)

Regardless of the sourcing, this is certainly an odd phrase in context. Up to that point, the only mention of "pseudoscience" was in the intro. 162.212.155.78 (talk) 21:33, 4 May 2023 (UTC)

I agree with Loki and Terringer that the intro "Unusually for a pseudoscience" is best removed. The pseudoscience point is clear and visible in several sections of the article, including the lede. It has not been marginalized. Yes, the phrase can be verified in the source but, as always, just because something is verifiable does not mean it is automatically WP:DUE as part of this sentence. WP:VNOT Cedar777 (talk) 21:54, 4 May 2023 (UTC)

Mostly what Cedar said. I do realize this is almost a direct quote from the source. That's why I said One academic book, however reliable, doesn't override several big WP:MEDORG sources that call EMDR an evidence-based treatment for PTSD (emphasis added). Loki (talk) 01:23, 5 May 2023 (UTC)

Adding boldface to the same argument based on irrelevant sourcing doesn't make it more convincing. MrOllie (talk) 01:54, 5 May 2023 (UTC)

The problem is an inconsistent sense of the word evidence. Nothing unusual for there to be a lot of evidence for a pseudoscientific treatment. However, this phrase is talking about randomized controlled trials, which are a very specific type of evidence, and a type that is specifically less likely to support pseudoscience. So let's not apples and oranges what the preponderance of sources support. DolyaIskrina (talk) 02:33, 5 May 2023 (UTC)

To briefly devil's advocate, that's why it's unusual. (However, y'know, WP:EXTRAORDINARY). Loki (talk) 00:50, 6 May 2023 (UTC)

I might be missing your point. Let me try to make mine better. The fact that randomized controlled trials have been done, is indeed unusual for a pseudoscience. It doesn't matter what the total number of studies is. What matters is what do the better studies show? Is there a relationship between the quality of the studies and the apparent effect? Do only the low powered crappy studies show the best results? And then there's EMDR's questionable origins and lack of a plausible mechanism. The elephant in the room is the generally sorry evidence base for most all psychotherapy. It's a low bar that EMDR is ambiguously clearing. IMO it's been approved by various organizations because it's popular and has a lot of otherwise respectable practitioners and it's not obviously harmful. You know, like Psychoanalysis, another pseudoscience. DolyaIskrina (talk) 04:01, 6 May 2023 (UTC)

My devil's advocated point is more or less the same as what you just said: the source says "unusual for a pseudoscience" because it's unusual for a pseudoscience to be supported by randomized controlled trials, seeing as randomized controlled trials are usually the gold standard for determining whether a treatment is effective.

But breaking out of devil's advocate mode, that triggers WP:EXTRAORDINARY: it's quite an extraordinary claim to say that a pseudoscience is supported by randomized controlled trials (or to put it another way, that something supported by randomized controlled trials is a pseudoscience), so we'd need more than just the one source that says it to say that.

(Also, big medical organizations don't in fact endorse psychoanalysis as treatment for anything, as far as I'm aware.) Loki (talk) 04:30, 6 May 2023 (UTC)

It's not really "supported" by RCTs, since the RCTs were all of shit quality, as we say. Loki is proposing some kind of convoluted synthesis which is unfathomable. Just reflect the high-quality source; it's not hard. Bon courage (talk) 05:54, 6 May 2023 (UTC)

The highest quality sources are the WP:MEDORG sources which are also the sources which call EMDR "evidence-based". Loki (talk) 06:36, 6 May 2023 (UTC)

Not doing this dumb argument again. WP:STICKTOSOURCE. Bon courage (talk) 06:44, 6 May 2023 (UTC)

useful more current (9/22) article

"Over the past decade, a seemingly unconventional treatment has wedged its way into mainstream therapy."

https://www.nytimes.com/2022/09/19/well/emdr-therapy.html

.

the attempted pseudoscience insertions here, based on 1 old ref, damage the article's credibility and are out of date. things have moved on. 5.66.63.86 (talk) 09:00, 6 May 2023 (UTC)

off topic
::::::::::::Steaming your vagina is even more popular.[1] Doesn't make it a good idea. Bon courage (talk) 09:07, 6 May 2023 (UTC)

The topic of this thread is the sentence intro "Unusually for a pseudoscience" when reflecting that sources support the fact that the subject has been subject to RCTs. There is no dispute that the subject, EMDR, has in fact been subject to RCTs. That part of the sentence is universally agreed upon and is DUE. It's the intro that several editors have issues with. The intro is contested and there is no consensus that it be included. WP:ONUS

Again, pseudoscience is clearly discussed in multiple locations in the article. It does not need to be included yet again in this sentence. Cedar777 (talk) 09:55, 6 May 2023 (UTC)

It does. Can’t cherrypick one factoid out of an observation. Bon courage (talk) 09:57, 6 May 2023 (UTC)

Collins dictionary defines pseudoscience as "a discipline or approach that pretends to be or has a close resemblance to science."

EMDR practitioners do not claim a science for EMDR. Thus it is not a pseudoscience.

It is just something that empirically works for some people (and thus is recommended by WHO, NICE etc).

works for some people. 5.66.63.86 (talk) 10:56, 6 May 2023 (UTC)

EMDR practitioners absolutely claim it's science, but that also is not our bar for what counts. We go with what the sources say. — Shibbolethink ^{(♔ ♕)} 15:43, 6 May 2023 (UTC)

IP 5.66.63.86, I'm afraid you are simply mistaken. Francine Shapiro, the founder, did publish her research in 1989 in the Journal of Traumatic Stress and present it as science. A number of people took issue with it, in particular Richard McNally. McNally was a vocal critic of EMDR for many years but he did revise his assessment after 2017 or so. A number of RCTs have been conducted and they have continued into the 2020s. According to the US Veterans Administration: "Since the early 1990s, there have been over 20 total randomized controlled trials (RCTs) of EMDR with adults, with more in progress."[2] The best quality WP:MEDRS sources don't have universal agreement about EMDR. The language and source we are discussing in this thread is from 2015. There have been additional RCTs that have taken place since then. We need to be carful with WP:DUEWEIGHT. Cedar777 (talk) 22:17, 6 May 2023 (UTC)

WP:EXTRAORDINARY as an argument doesn't do much here, given that the source we're using is actually extremely high on the quality ladder.

It is an expert-authored (Lilienfeld, Lynn, Gambrill, Herbert, Gaudiano, Lohr, Mann, Rosen, Gist, Barden, Tavris, McNally, Mercer, Loftus), expert-edited (Thyer and Pignotti), topic-relevant (has more than a dozen pages dedicated to EMDR) academic review monograph published by a very high impact publishing house (Springer). It doesn't get much better than that.

Then we also have sources like these to help back it up: [3][4][5][6] Each of these emphasizes that EMDR, while not an obvious pseudoscience at first glance, still meets many of its criteria, despite the many studies conducted on it, due to the poor design of such studies. That's what we say here, ergo: easily satisfies ECREE. — Shibbolethink ^{(♔ ♕)} 15:48, 6 May 2023 (UTC)

Sorry to extend this tangent, I won't comment beyond this, but the evidence for Psychoanalysis looks very similar to EMDR and in 2010 the APA called psychoanalysis "empirically validated" DolyaIskrina (talk) 17:12, 6 May 2023 (UTC)

Sources

also off topic
ridiculous. I'm sure somebody somewhere, to use an example above, thinks thinks that "Steaming your vagina" has a science basis. That does not mean that is the consensus view. 5.66.63.86 (talk) 17:19, 6 May 2023 (UTC)

Commenting here to say that earlier today I edited the opening of that sentence out (admittedly without looking at the talk page first, as it seemed pretty unambiguously mistaken to me at the time), though my edit has since been reverted. The reason why I did so is not because of the arguments mentioned here so far, but because the claim that most pseudosciences haven't had RCTs (which is the context of the phrase being debated) is very questionable, verging on false. As mentioned in my edit notes, well-known pseudoscientific fields (such as parapsychology, homeopathy, and even dowsing!) have been subject to many RCTs! These randomized controlled studies usually find the pseudoscience not to be effective, of course, but that does not alter the fact that it is simply not that unusual for scientists to conduct RCTs on a pseudoscientific field. This should be obvious; after all, a field is usually only established as pseudoscientific after scientists have looked into it and discarded the relevant hypotheses!

In my opinion, we should state that RCTs have been conducted, because that is both true, citable, and (probably) notable, but we should not claim that the mere fact that this is the case is "unusual for a pseudoscience". This is all outside of the ongoing debate as to whether the subject is actually pseudoscientific or not; my objection to the statement (as it stands) holds regardless of how that debate plays out.

Yitz (talk) 03:15, 8 May 2023 (UTC)

I went to the source assuming that it said something like "positive RCTs", but y'know, you're right. It just says What sets EMDR apart from most approaches considered to be pseudoscientific is that a number of RCTs have been conducted on EMDR, leading it to be listed as an empirically supported treatment for PTSD by the Division 12 of the American Psychological Association, because it meets that group’s criteria of having at least two randomized controlled studies with positive results. Nevertheless...

It definitely implies that it means positive RCTs, but it doesn't say that. Loki (talk) 03:59, 8 May 2023 (UTC)

Unless anyone has any further objections, I'm going to go ahead and revert the reversion on my prior edit. If that's not okay for any reason, please let me know. I'm also going to do some more research on this subject in general, as I'm getting the sense (from both the edit history and talk page) that the way the article is currently written may not reflect the general consensus. Additionally, I mentioned this article to a liscensed therapisty yesterday, who claimed that the page is quite outdated and that the mainstream consensus in her field is currently leaning in favor of EMDR. Are there any "must-read" threads in the talk page archives (or elsewhere) I should peruse before editing further? Yitz (talk) 21:23, 8 May 2023 (UTC)

@Yitzilitt The "general consensus" according to wikipedia's WP:MEDSCI is determined by secondary peer-reviewed journal articles published in expert-edited topic-relevant journals, and similar peer-reviewed books and monographs, not a single random therapist. Those articles state EMDR is helpful as a tool, but that it's "special sauce" e.g. eye movements are likely not independently efficacious when compared to similar therapies without such movements. AKA it is a purple hat therapy.

If you want to make broad changes to the article, you should start an RFC, not just state you're going to start making changes. The "untestable hypothesis" is the claim put forward by multiple EMDR practitioners that the mechanism is different in several different studies, moving the goalposts, refusal to use proper control groups because of these "special mechanisms". E.g. that the eye movements in EMDR create a "special state" in which memories are rewritten. This is not testable with current technology. [7] — Shibbolethink ^{(♔ ♕)} 21:28, 8 May 2023 (UTC)

@Shibbolethink I am aware of how WP:MEDSCI works. Apologies if my wording was confusing; what I meant was simply that this encounter served as anecdotal evidence for my suspicion that something may be amiss here, and made me think that I should do more research. I mentioned it because in the past I've found that sharing some details of my thought process in the talk page has been helpful to others. (for example, getting people in touch with domain experts who may have more resources than me, or retracing how someone found a particular source, etc.). Yitz (talk) 21:36, 8 May 2023 (UTC)

Re Are there any "must-read" threads in the talk page archives (or elsewhere) Have a look at Wikipedia:Fringe_theories/Noticeboard/Archive_92#EMDR MrOllie (talk) 21:43, 8 May 2023 (UTC)

@Shibbolethink So just to be clear, the following three claims are all distinct:

A) While EMDR is an effective treatment, the effectiveness is due primarily to the exposure-like parts and not the eye-movement parts.

B) EMDR is a purple hat therapy, i.e. it's an ineffective treatment added to a treatment already known to be effective to create the impression of a new effective treatment.

C) EMDR is pseudoscientific, i.e. it's a clearly bogus or unfalsifiable treatment that claims to be a scientific evidence-based treatment.

Why are A and B distinct? Because being a treatment with exposure-like parts is not the same as being exposure + eye movements: it's possible that the exposure parts of EMDR and the exposure parts of CBT have clinically relevant differences despite operating on the same principle, and the sources appear to differ on this point. We do know there are some differences (for instance, traditional CBT focuses more on IRL exposure while EMDR focuses more on imaginal exposure) but it's not really clear what the clinical relevance of these differences are.

I'm making this point because we see a lot of A in the sources from highly respected sources even now. But the amount of B and C decreases the more modern the source gets, and conversely the more modern sources contain more explicit contradictions of C and sometimes even B. Loki (talk) 15:40, 11 May 2023 (UTC)

Once knowledge is settled it doesn't need renewing. Your assertion about "explicit contradictions" is false (if you mean in RS, otherwise why raise it?). Bon courage (talk) 15:55, 11 May 2023 (UTC)

it's possible that the exposure parts of EMDR and the exposure parts of CBT have clinically relevant differences despite operating on the same principle, and the sources appear to differ on this point
I know of no reliable non-EMDR sources which assert this. Literally none. Do you have quotes? Classical exposure therapy does not focus "more on IRL exposure", it includes exposure through thought and visualization. CBT is not exposure therapy. E.g. [8] Exposure therapy is often used in tandem with CBT but they are distinct. A and B are roughly equivalent, B is a further explanation of A. C often follows from A and B, and is described as following from A and B in our most reliable sources. None of this is a good reason to get rid of well-sourced content. — Shibbolethink ^{(♔ ♕)} 16:34, 13 May 2023 (UTC)

The example that comes to my head immediately is that a bunch of the meta-analyses say that EMDR is often more accepted by patients (i.e. has a lower dropout rate) than traditional CBT.

But furthermore, many sources treat A and B as clearly distinct. So for instance the Australian medical authority calls EMDR highly evidence-based, and also says that it's very similar to exposure. So does Bessel van der Kolk, who outright calls EMDR a form of exposure therapy, and also endorses it highly. Neither of these sources call EMDR a purple hat therapy, and while this is admittedly conjecture, I think it's very clear that neither of these sources would call EMDR a purple hat therapy.

And that that's not because they think the eye movements are particularly effective, because it's reasonably clear that they don't. Both of them endorse EMDR as a form of exposure therapy. Loki (talk) 17:37, 13 May 2023 (UTC)

None of those sources actually address the concept of EMDR as incorporating evidence-based practices and then adding non-evidence based ones on top of it, as in a purple hat therapy. To say in article text that they support that EMDR is not a purple hat therapy, or to use those to remove the purple hat therapy content, would be WP:SYNTH, as they do not actually address that claim. That appears to be your interpretation. — Shibbolethink ^{(♔ ♕)} 17:49, 13 May 2023 (UTC)

Shibbolethink is right (as usual). As Samuel L Jackson once said, 'The absence of evidence is not evidence of absence'. When a source is silent on an issue that cannot be taken to mean they agree with your position. MrOllie (talk) 17:57, 13 May 2023 (UTC)

I strongly agree with removing this. Unambiguously calling EMDR "a pseudoscience" is a strong and controversial position on what is clearly a subject of much current debate in the scientific community, and therefore a violation of WP:NPOV. From WP:FRINGE/QS: "Articles about hypotheses that have a substantial following but which critics describe as pseudoscience, may note those critics' views; however, such hypotheses should not be described as unambiguously pseudoscientific if a reasonable amount of academic debate still exists." Nowhere else in the article is the pseudoscience claim stated without qualification. Even the cited source does not call EMDR a pseudoscience, but rather an "approach... considered to be pseudoscientific." Paraphrasing that to an unambiguous claim that EMDR is a pseudoscience is absolutely unverified and non-neutral. GreatBigCircles (talk) 18:24, 29 May 2023 (UTC)

There is no debate about pseudoscience. Follow the sources. Bon courage (talk) 19:08, 29 May 2023 (UTC)

I am following the sources:

There’s some controversy surrounding why EMDR works. The creator of EMDR, Dr. Francine Shapiro, later developed a working theory about how your brain stores memories after accidentally discovering the eye movement technique she later used to create this therapy technique. However, that controversy doesn’t extend to whether or not EMDR does work. Dozens of controlled trials and research studies have analyzed EMDR and shown that it’s effective.
— "EMDR Therapy: What It Is, Procedure & Effectiveness". Cleveland Clinic.

Today, clinicians generally consider E.M.D.R. an effective treatment for trauma.... But scientists are debating whether E.M.D.R. is more effective than other trauma treatment methods.
— Blum, Dani; Park, Sophie (2022-09-19). "'One Foot in the Present, One Foot in the Past:' Understanding E.M.D.R." The New York Times. ISSN 0362-4331.

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. The variable findings regarding whether its effects are for reasons unique to this treatment, however, have become the focus of extensive discussion and debate.
— Sikes, Charlotte & Sikes, Victoria. (2003). EMDR: Why the controversy?. Traumatology. 9. 169-182. 10.1528/trau.9.3.169.22270.

EMDR appears to be a safe therapy, with no negative side effects. Still, despite its increasing use, mental health practitioners debate EMDR's effectiveness. Critics note that most EMDR studies have involved only small numbers of participants. Other researchers, though, have shown the treatment's effectiveness in published reports that consolidated data from several studies.
— "EMDR: Eye Movement Desensitization and Reprocessing". WebMD.

GreatBigCircles (talk) 17:26, 30 May 2023 (UTC)

And? None of this is about pseudoscience. It's effective because of the basis it co-opts. Doesn't stop it being a pseudoscience. This has been discussed ad nauseam now at multiple noticeboards. Bon courage (talk) 17:35, 30 May 2023 (UTC)

this article is a disaster for wikipedia.

2 people insist on inserting "Unusually for a pseudoscience, " out of context into a section on effectiveness. 5.66.63.86 (talk) 18:47, 30 May 2023 (UTC)

The context is that it directly follows the wording of the source. It would be misrepresenting the source to include only half the sentence. MrOllie (talk) 20:01, 30 May 2023 (UTC)

As I pointed out in my original comment, it is the phrase in question that is misrepresenting the source: Even the cited source does not call EMDR a pseudoscience, but rather an "approach... considered to be pseudoscientific." GreatBigCircles (talk) 20:33, 30 May 2023 (UTC)

It is in a chapter titled Pseudoscience in Treating Adults Who Experienced Trauma. A couple quotes: Another way in which EMDR qualifies as a pseudoscience... ... EMDR has been said to use social influence strategies that are consistent with those used by other forms of pseudoscience MrOllie (talk) 20:40, 30 May 2023 (UTC)

Very well, thank you for the additional quotes; I concede that the original source is not misrepresented. However, as has been pointed out above, one source against a mountain of scientific evidence does not warrant such a biased treatment in this article. GreatBigCircles (talk) 21:11, 30 May 2023 (UTC)

There isn't a 'mountain of scientific evidence'. Please read prior discussion thoroughly. There is a 'mountain of scientific evidence' that exposure therapy works. That does not equate to evidence that EMDR's additions make it any better than other forms of exposure therapy. MrOllie (talk) 21:16, 30 May 2023 (UTC)

There is clearly no consensus here (nor in the scientific community). The disputed claim should be removed until a consensus is reached.

I'm genuinely confused and curious about why a couple of active editors seem to be so attached to ensuring that alternative viewpoints don't get represented in this article. What is it you're worried about? That someone will consider EMDR a serious treatment, as countless professionals do? That they'll be hoodwinked by some charlatan who takes their money and... administers a treatment that is well established as safe and just as effective as any other treatment, but based on some non-scientific theories? From the outside, it really looks like you're being reactionary, unilaterally blocking other people's good faith efforts to improve the neutrality of this article in order to avoid lending any credibility to something you see as contemptible. I don't want to assume that, though, which is why I would love to know what value you're actually trying to protect. I imagine it's one we share.

EDIT: In the struck text above, I was attempting to find shared values as a first step toward compromise, but I got some feedback that it might have been interpreted as a personal attack. I can see how it might have come across that way, and I apologize. I'm leaving it struck out because I'm not sure of the correct protocol for editing a message that's been responded to. GreatBigCircles (talk) 22:06, 30 May 2023 (UTC)

@GreatBigCircles: I quote here from WP:PA: "Comment on content, not on the contributor(s)." JoJo Anthrax (talk) 22:18, 30 May 2023 (UTC)

The sources say it (probably) works; the sources say it's pseudoscience. Wikipedia reflects those sources. Job done. GreatBigCircles seems to think that one lot of sources "cancel out" others. This is both WP:OR and fallacious reasoning (relatedly, see Purple hat therapy), which manifests as WP:PROFRINGE. The PAs on top do not help - this topic has already been aired an WP:ANI (where incidentally, it was said our article is being too coy about the pseudoscience). Bon courage (talk) 03:36, 31 May 2023 (UTC)

NPOV dispute: pseudoscience and evidence

Unambiguously presenting EMDR as a pseudoscience without acknowledging the scientific support for it is a strong and controversial position on a subject of much current debate in the scientific community, and therefore a violation of WP:NPOV. From WP:FRINGE/QS: Articles about hypotheses that have a substantial following but which critics describe as pseudoscience, may note those critics' views; however, such hypotheses should not be described as unambiguously pseudoscientific if a reasonable amount of academic debate still exists.

I have been attempting to add well-sourced factual information to this article about the abundant evidence that EMDR is safe and effective, without removing any of the statements about it being called a pseudoscience. I am attempting to add a little bit of balance to an article that is very heavily slanted toward a particular, controversial view. My edits have been cited with multiple reliable sources. However, they have been summarily and repeatedly reverted. Therefore, I have added the POV tag to the article. It should remain until the article presents a more balanced perspective and draws more attention to the scientific evidence supporting this practice.

Here are a few of the reliable sources discussing the EMDR controversy:

There’s some controversy surrounding why EMDR works. The creator of EMDR, Dr. Francine Shapiro, later developed a working theory about how your brain stores memories after accidentally discovering the eye movement technique she later used to create this therapy technique. However, that controversy doesn’t extend to whether or not EMDR does work. Dozens of controlled trials and research studies have analyzed EMDR and shown that it’s effective.
— "EMDR Therapy: What It Is, Procedure & Effectiveness". Cleveland Clinic.

Today, clinicians generally consider E.M.D.R. an effective treatment for trauma.... But scientists are debating whether E.M.D.R. is more effective than other trauma treatment methods.
— Blum, Dani; Park, Sophie (2022-09-19). "'One Foot in the Present, One Foot in the Past:' Understanding E.M.D.R." The New York Times. ISSN 0362-4331.

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. The variable findings regarding whether its effects are for reasons unique to this treatment, however, have become the focus of extensive discussion and debate.
— Sikes, Charlotte & Sikes, Victoria. (2003). EMDR: Why the controversy?. Traumatology. 9. 169-182. 10.1528/trau.9.3.169.22270.

EMDR appears to be a safe therapy, with no negative side effects. Still, despite its increasing use, mental health practitioners debate EMDR's effectiveness. Critics note that most EMDR studies have involved only small numbers of participants. Other researchers, though, have shown the treatment's effectiveness in published reports that consolidated data from several studies.
— "EMDR: Eye Movement Desensitization and Reprocessing". WebMD.

Again, I am not interested in removing any of the criticisms of EMDR from the article, only in improving the neutrality by acknowledging that EMDR is a subject of valid academic disagreement.

More information is available in the "Unusually for a pseudoscience" section above. GreatBigCircles (talk) 22:37, 30 May 2023 (UTC)

is there a wiki process whereby this long-running and important argument can be referred upwards to a star chamber of senior editors for adjudication? 5.66.63.86 (talk) 03:20, 31 May 2023 (UTC)

You could raise it (again) at WP:FT/N to get lots more attention. Bon courage (talk) 03:26, 31 May 2023 (UTC)

WebMD and Cleveland clinic are not reliable for anything much. And why raise lay sources when there are peer-reviewed journal articles and academic textbooks available? Bon courage (talk) 03:39, 31 May 2023 (UTC)

One of the issues here is that EMDR organisations get tempted into putting forward a science theory for EMDR. e.g. https://emdr-europe.org/ mention of "unprocessed memories".

It would be better if the EMDR organisations instead just said "The scientific explanation for the effectiveness of EMDR is not known."

Then everyone could focus on the empirical fact that many people find EMDR very valuable in resolving trauma. 5.66.63.86 (talk) 04:09, 31 May 2023 (UTC)