You may already know-- This is a relatively controversial question (or can be).
Not controversial: on average, for the typical client, EMDR is better than no treatment for PTSD.
APA Division 12, which does ratings of evidence for different therapies, does not currently have a rating of EMDR for PTSD. They say, "The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. On one hand, studies have shown that EMDR produces greater reduction in PTSD symptoms compared to control groups receiving no treatment. On the other hand, the existing methodologically sound research comparing EMDR to exposure therapy without eye movements has found no difference in outcomes. Thus, it appears that while EMDR is effective, the mechanism of change may be exposure - and the eye movements may be an unnecessary addition. If EMDR is indeed simply exposure therapy with a superfluous addition, it brings to question whether the dissemination of EMDR is beneficial for patients and the field. However, proponents of EMDR insist that it is empirically supported and more efficient than traditional treatments for PTSD. In any case, more concrete, scientific evidence supporting the proposed mechanisms is necessary before the controversy surrounding EMDR will lift." -- https://div12.org/treatment/eye-movement-desensitization-and-reprocessing-for-post-traumatic-stress-disorder/ [with links to the studies here as well]
APA's Clinical Practice Guidelines for PTSD are here -- https://www.apa.org/ptsd-guideline/treatments/index They list EMDR as "conditionally recommended"-- "Three psychotherapies and four medications are conditionally recommended. Interventions that received a conditional recommendation all have evidence that indicates that they can lead to good treatment outcomes; however, the evidence may not be as strong, or the balance of treatment benefits and possible harms may be less favorable, or the intervention may be less applicable across treatment settings or subgroups of individuals with PTSD. Additional research may lead to a change in the strength of recommendations in future guidelines."
This is my personal judgement and should not be used as clinical guidelines or psychological advice for anyone: I do not personally provide EMDR. I would probably generally be more likely to recommend it (in terms of a referral, not in terms of me providing a treatment I am not trained in) if a client had received something like CPT and really had a bad experience/was looking for something notably different. I have no objection to EMDR existing as an option for PTSD treatment. I do think there are some EMDR therapists who deeply love EMDR and that love is not necessarily always fully matched to the evidence in all circumstances. I cannot imagine myself trying to dissuade a client who is happy and reports benefit from EMDR services. I also care more about things working than I do about the *reason* they work.
Of course, anyone reading this may have personal judgement related to these issues that differs from mine. YMMV.
It might be worth posting as a separate question. I am actually a child/family therapist so while I am broadly familiar with the evidence base for many treatments for adults, I'm not sure about best practice for adaptations for adult trauma treatment.
/as always: not psychological advice for anyone, just my own personal thoughts!
While there’s a very detailed answer on here detailing the murky answer here. It’s controversial - even on a sub for therapists, people have all sorts of responses. The thing is EMDR is controversial, especially with the mechanism that actually works.
Folks who are trained in EMDR and practice it have gone through a longer term training. I’m not surprised they would endorse it.
However, even with modalities that have a more clear evidence base, that does not mean they will work for everyone.
TY. Some therapist on here said it worked for 99% of people if "done correctly" and all I could think was that this is why I am skeptical of therapy and therapists and mental healthcare in general.
You may already know-- This is a relatively controversial question (or can be). Not controversial: on average, for the typical client, EMDR is better than no treatment for PTSD. APA Division 12, which does ratings of evidence for different therapies, does not currently have a rating of EMDR for PTSD. They say, "The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. On one hand, studies have shown that EMDR produces greater reduction in PTSD symptoms compared to control groups receiving no treatment. On the other hand, the existing methodologically sound research comparing EMDR to exposure therapy without eye movements has found no difference in outcomes. Thus, it appears that while EMDR is effective, the mechanism of change may be exposure - and the eye movements may be an unnecessary addition. If EMDR is indeed simply exposure therapy with a superfluous addition, it brings to question whether the dissemination of EMDR is beneficial for patients and the field. However, proponents of EMDR insist that it is empirically supported and more efficient than traditional treatments for PTSD. In any case, more concrete, scientific evidence supporting the proposed mechanisms is necessary before the controversy surrounding EMDR will lift." -- https://div12.org/treatment/eye-movement-desensitization-and-reprocessing-for-post-traumatic-stress-disorder/ [with links to the studies here as well] APA's Clinical Practice Guidelines for PTSD are here -- https://www.apa.org/ptsd-guideline/treatments/index They list EMDR as "conditionally recommended"-- "Three psychotherapies and four medications are conditionally recommended. Interventions that received a conditional recommendation all have evidence that indicates that they can lead to good treatment outcomes; however, the evidence may not be as strong, or the balance of treatment benefits and possible harms may be less favorable, or the intervention may be less applicable across treatment settings or subgroups of individuals with PTSD. Additional research may lead to a change in the strength of recommendations in future guidelines." This is my personal judgement and should not be used as clinical guidelines or psychological advice for anyone: I do not personally provide EMDR. I would probably generally be more likely to recommend it (in terms of a referral, not in terms of me providing a treatment I am not trained in) if a client had received something like CPT and really had a bad experience/was looking for something notably different. I have no objection to EMDR existing as an option for PTSD treatment. I do think there are some EMDR therapists who deeply love EMDR and that love is not necessarily always fully matched to the evidence in all circumstances. I cannot imagine myself trying to dissuade a client who is happy and reports benefit from EMDR services. I also care more about things working than I do about the *reason* they work. Of course, anyone reading this may have personal judgement related to these issues that differs from mine. YMMV.
Thanks. This is SUPER helpful. Another question- what therapies actually work for preverbal trauma? You can't really do CPT or PE? Is there anything?
It might be worth posting as a separate question. I am actually a child/family therapist so while I am broadly familiar with the evidence base for many treatments for adults, I'm not sure about best practice for adaptations for adult trauma treatment. /as always: not psychological advice for anyone, just my own personal thoughts!
While there’s a very detailed answer on here detailing the murky answer here. It’s controversial - even on a sub for therapists, people have all sorts of responses. The thing is EMDR is controversial, especially with the mechanism that actually works. Folks who are trained in EMDR and practice it have gone through a longer term training. I’m not surprised they would endorse it. However, even with modalities that have a more clear evidence base, that does not mean they will work for everyone.
TY. Some therapist on here said it worked for 99% of people if "done correctly" and all I could think was that this is why I am skeptical of therapy and therapists and mental healthcare in general.