Am I a good candidate for EMDR?
April 12, 2018 7:41 AM   Subscribe

My new therapist has been encouraging me to try EMDR for my depressive symptoms. I’m hella skeptical, so I’d like to gain some perspective from the hive mind.

Background: I’m a cis-female in my early 30s, have been experiencing the following depressive symptoms for almost a year: lethargy, apathy, increased substance use/abuse, emotional flagellation, overeating, lots of sleeping, lack of concentration, lack of interest in hobbies or social activities, noticeable decrease in hygiene, general suicidal ideation.

My current therapist is nice, but is a big proponent of EMDR. The focus of our most recent sessions have shifted from discussing current stressors to identifying past traumas in my life (as a prep for EMDR).

From my understanding, EMDR is used to treat PTSD and trauma related to specific incidents. Though I do have a history of trauma (panic attacks, emotional/physical abuse, sexual assault), I feel that I’ve addressed those issues in therapy sessions in years past, and these past events have minimal to no impact on my daily life.

I feel that my current depressive state has less to do with past trauma and is instead linked to present stressors at work (demanding job) and home (strained relationship due to less free time and health issues), along with our current dismal socio-political climate.

When I share current stressors in my life, my therapist now shifts the focus to past traumas and triggers. For example:

Me: I feel trapped in my job/home/relationship
Therapist: Let’s explore some other times in your childhood where you felt ‘trapped’

OR

Me: I feel like I’m constantly disappointing people at work/home because my brain is foggy, I have no energy, and I can’t think straight, so I’m just dropping the ball a lot.
Therapist: Do you feel like “disappointing people” is a trigger for your depressive thoughts?
Me: Not really. I feel like most people feel crappy when they let people down. It’s my depression that’s causing me to let people down, not vice versa.

My homework this week is to isolate particularly triggering incidents from my past. I have to be honest, I don’t feel like this is a worthwhile exercise. I don’t feel particularly triggered, I just feel sad and hopeless all the time. I don’t see the point of digging up sad, seemingly unrelated memories from the past.

I’ve explained all of this to my therapist and and I don’t feel like I’ve received a very reasonable explanation as to how EMDR can help me.
However, I realize that there is a part of me that is preinclined to be quite skeptical of Woo and Woo-adjacent techniques, so I want to be open-minded if this is something that could actually help me.

I would be less skeptical if I had some outside perspective from people who’ve been in similar situations (depression that is not specifically linked to isolated traumatic events).

Thanks in advance for your help.
posted by chara to Human Relations (18 answers total) 8 users marked this as a favorite
 
I see EMDR as a low-risk strategy with a potential for high reward. I did have some brief EMDR therapy once before my insurance changed and though there was a lot about it that I got frustrated with, I did find it helpful. I don’t have a specific traumatic event that we were targeting, just general difficulties in childhood.

In general when I face this kind of question I try to take the approach that if I don’t trust my therapist I should look for another one, and if I do I should give their recommendations a shot.

I think it would be worthwhile to ask your therapist why they think your past is still an issue contributing to your depression. Give them some idea of the kind of answer that would satisfy you.

I’m sorry you are dealing with this. Depression really sucks.
posted by bunderful at 8:06 AM on April 12, 2018 [2 favorites]


There's some evidence that knitting has similar positive effects as EMDR. Knitting can be an expensive hobby, but to start with, it may be cheaper than pursuing traditional EMDR. You may find you receive benefits from it that would be associated with the goals of EMDR without having to actually do EMDR.

You're positively constructing something and you literally can see it grow. You may try this as a "middle ground" with your therapist and if you're so inclined. Plus knitting groups at shops are full of the best kinds of people.

That said, it sounds like your therapist isn't really listening to you and it's hard to know if the therapist is advocating for something they truly believe is in your best interests or are really missing the mark, but I think you should continue to say what you think is best for you.
posted by zizzle at 8:07 AM on April 12, 2018


Without commenting on your particular situation, I would say that a lot of times the ways we respond to current stressors, the stories we tell ourselves about why those things are stressful, are based on past experiences (often childhood experiences) of similar stress. So someone who got a consistent message of "Everyone is human and makes mistakes and that's ok and you're still lovable and worthwhile" is likely to react to missing a deadline much differently from someone who got messages of "How dare you make a mistake omg omg omg this is horrible you are worthless now everything is ruined." Or who went through a major trauma and experienced victim-blaming (internally or externally) that was never successfully challenged or resolved, and now believes at some level that if they make a mistake, REALLY BAD THINGS could happen.

Sometimes, by resolving the internalized beliefs and feelings of those past situations (whether that's through EMDR or CBT schema therapy or visualization or other techniques), we develop much greater creativity and flexibility in dealing with the current stressors, because we're not as locked into the "old tapes" in our heads.
posted by lazuli at 8:09 AM on April 12, 2018 [23 favorites]


I am really into evidence-based medicine. That said, I did EMDR and it was (for lack of a better term) life-changing. Like bunderful said, it is fairly low-risk, high-reward. If your insurance covers it, I would encourage you to try it.

However, it also sounds like you may not be "clicking" with your therapist, so you may also consider looking for a new therapist instead.
posted by sockermom at 8:45 AM on April 12, 2018 [5 favorites]


I've tried it with my therapist, who is awesome and an excellent therapist, but it just doesn't do much for me - in general, my cognitive mind has such a death grip on the rest of me, that I can't easily and readily access how certain experiences or memories felt, although I can describe them otherwise. Hypnosis didn't work on me for the same reason. But it's worth giving it a try - as other people have said, it's low-risk, and has the potential to be high-reward.
posted by Aubergine at 8:50 AM on April 12, 2018


Important note to add: my insurance does not cover this, so I am using my HRA account to pay for therapy sessions. Because I'm using limited funds and my current job schedule is hectic, I want to feel sure I'm not wasting money or time continuing this treatment.
posted by chara at 9:16 AM on April 12, 2018


I can't speak to whether EMDR would for sure help your current state of mind, since you don't see the connection your therapist does between that and your past traumas. But, the 4 or 5 sessions of EMDR ( paid out of pocket) I had 16 years ago were life changing and I am so glad I gave it a try. I also didn't see the connection between the past traumas and my then state of mind, but a huge, not previously recognized burden was lifted permenantely off my psyche after the sessions and that made a big difference in my day to day.
posted by Rapunzel1111 at 9:47 AM on April 12, 2018 [4 favorites]


I think almost any therapeutic approach is mostly only worthwhile if you feel good/optimistic about it. This is not to say "keep a positive attitude!" but rather to say if you don't think it's going to work, it's probably not a good approach for you to try unless you go in with the spirit of "can't hurt, may as well try it."

It seems a little like your therapist is responding to the fact that you're presenting your depression as something a therapist can't do anything about. Therapists can't change who's the president, but they can try things like EMDR or psychodynamic treatment that are meant to change maladaptive responses to difficulties. But if she's choosing approaches that aren't for you and not responding when you say "that's not for me," you may have the wrong therapist.

FWIW EMDR feels woo-adjacent to me, too, and I went for a couple of sessions of the clicker version because it was supposed to be a thing that could help with a phobia, and it felt like a waste of time. (It didn't help that the therapist had a nails-on-the-blackboard annoying voice in an approach where you are sitting and listening to them drone on!)
posted by Smearcase at 10:43 AM on April 12, 2018 [2 favorites]


This is not related to therapy, but I am a female in my late 30s and a few years back was experiencing extreme brain fog, trouble concentrating, etc., and my doctor suggested she put me on a low-dose antidepressant (I've been on them before to good results). Because I didn't really have any other depression-related issues, I asked that first, she test my iron levels and I discovered that my iron stores were practically nonexistent, like at levels where other people are getting IV infusions to boost up their stores. I've been on oral iron supplements (just over the counter) for the last couple years and have not experienced the brain fog/concentration issues since, EXCEPT when I went off them at her suggestion. It might be worth getting your iron/ferritin levels tested in addition to seeking out therapy, unless brain fog is an issue that you know is related to your depression.
posted by jabes at 10:59 AM on April 12, 2018 [3 favorites]


Ok. So. I'm a researcher who studies PTSD/trauma/sexual assault. I'm also a clinician who treats PTSD. I'm involved in treatment development/testing research. My closest collaborators do a lot more of it. So I know this research and field really well. I have no financial or personal investment in any particular treatment working (in fact, I don't get paid to do treatment). My main motivation is that literally millions of people have PTSD, which is one of the most treatable mental health disorders, and when they go to a therapist, 9/10 times they will not even get offered a treatment that has evidence of its ability to treat that disorder. Most people's symptoms can be reduced by about half within a few months, but instead, people stay in bunk treatments for years. They spend money, and time, and carry all the risks of having PTSD (e.g., social isolation, suicide) for that time. I want to do whatever I can to reduce that burden.

So let me explain why I do not recommend EMDR for PTSD, let alone other conditions.

One of the two evidence-based treatments for PTSD uses exposure therapy. The theory of exposure therapy is that people with PTSD have a conditioned association between trauma-related stimuli and a strong fear response, so they typically avoid those stimuli. Helping people gradually expose themselves to objectively safe stimuli without avoiding or leaving the situation will correct those associations, because fear responses burn themselves out quickly. It's just like if you're afraid of dogs, and make yourself spend more time around dogs- they will almost always stop being as scary.

Exposure therapy confronts avoidance of trauma-related thoughts/emotions by asking patients to repeat the story of the trauma over and over again, in the present tense, with a lot of detail. The changes patients experience when doing this are amazing- I've had patients sobbing through the story in one session and yawning through it 4 weeks later. It's not magic- when you practice something scary, it becomes less scary.

EMDR practitioners ask patients to do the same thing--tell the story of the trauma or think about it--and direct them to move their eyes while doing it. Because it uses the active ingredient of exposure, EMDR still works when done correctly (although the research to demonstrate this tends to be lower-quality, and the recent APA treatment recommendations gave it a "conditional" rather than "strong" recommendation in light of this). The problem is, EMDR practitioners argue that it's the eye movements that are the active ingredient, and not the exposure. There is no known neurological reason why eye movements would work to reduce symptoms of ANY disorder. The eye movements weren't added because of any neuroscience, but the idea that your brain can be reprogrammed through your eyes sounds vaguely neurosciency, and as a result is viewed as "cutting edge" when it's really just a proprietary addition to a well-known treatment. Aside from my concerns with making an industry out of effective treatments (EMDR training and equipment costs thousands) or offering a therapy without a theoretical basis, I genuinely don't have a problem with whatever bells and whistles you add to therapy if it gets therapists to offer it and gets patients to do it. I'm SO happy that people with PTSD have benefitted from it- I'm 100% for that.

BUT. The problem is, when you have something incorrectly framed as an "active ingredient," therapists will (with the best intentions) remove all elements from that treatment other than what they believe to be the active ingredient, and then inappropriately apply what they believe to be the active ingredient to other conditions. Exposure is HARD to do, both as a therapist and as a patient, and it's easy to want to avoid it if you have something that's less aversive that you believe will work. When therapists leave out the exposure and just do the eye movements, EMDR will not work. I talked to a woman who got EMDR and told me that her therapist would have her start to tell the story of the trauma, but as soon as she began to get upset, the therapist would have her stop and switch to what she said was the important part, which is the eye movements. In addition to failing to extinguish her fear response, this communicates to this patient that she's too fragile to handle her fear. This woman was in EMDR for ***3 years***. The majority of my patients don't have PTSD anymore after 12 weeks of exposure therapy, for comparison.

As a result of this, EMDR is widely viewed in the PTSD research community with strong skepticism. I almost view it like the climate change debate at this point- the people actually doing the research are pretty much in unanimous agreement (with the exception of a small contingent of people who are largely unconnected to the rest of the community whose research is focused on EMDR) that there's no reason to think eye movements are needed, but there are enough people who don't do the research who have bought in that it's seen as a debate.

All that said. I just did a quick literature search on EMDR for depression. There have been no trials examining the use of EMDR for depression that's not comorbid to PTSD. The APA clinical practice guidelines for depression, based on an extensive review of the empirical research, are summarized here. Best practice for treating depression is pharmacotherapy and/or the following types of psychotherapy: cognitive behavioral therapy (CBT- this is an umbrella that includes behavioral activation and cognitive therapy), interpersonal psychotherapy, or problem-solving therapy. If you're not sure that you're getting that, ask- all of these treatments are short-term (~16 weeks) and manualized, and your therapist should be able to readily name one of them when you ask what it's called.

tl;dr- There is no scientific or theoretical reason to believe that eye movements are needed to treat PTSD, and there's definitely no reason to believe they treat depression. When done correctly (i.e., involving exposure), EMDR appears to work, but it's likely often done incorrectly in practice due to the belief that eye movements are the important part- and this could be harmful. Effective treatments for depression exist, but EMDR isn't on that list.
posted by quiet coyote at 12:41 PM on April 12, 2018 [47 favorites]


I had a powerfully transformative experience with EMDR to address patterns, issues, and reactive feelings relating to what I'll call quotidian trauma. I have not suffered major trauma like assault, abuse, major accident, anything like that. But my emotional experience of some of my childhood and young adult interactions rose to the level of creating little areas of dysfunction, that sort of coalesced into a larger pattern of things not working well. EMDR was a big, big help in moving through a lot of that into a clearer way of interacting and engaging in my daily life.
posted by spindrifter at 1:59 PM on April 12, 2018


I am dating a person who has been to two EMDR sessions (so far) and is a big proponent of it. She feels like it has caused her thoughts on specific incidents to shift dramatically so those memories feel different and less triggering.

It sounded weird to me at first, but after hearing her talk about it, I think it might be worthwhile even for a placebo effect.
posted by tacodave at 4:51 PM on April 12, 2018 [1 favorite]


EMDR solved my trauma-based PTSD.

I don’t see any risks to trying it.
If it works for you, it will be immediately obvious.

Give it a try. Nothing to lose.
posted by littlewater at 6:06 PM on April 12, 2018 [1 favorite]


I paid out of pocket for EMDR treatment. It was the best money I’ve ever spent on myself. I was suffering from general anxiety and hadn’t really seen that it was connected to a bunch of childhood crap that was, in fact, traumatic (even though I wanted to dismiss it).

It got me through a rough patch fast - so in a sense, it was the less expensive option! And it helped me quickly - like from week to week I felt progress out of the mental loops that I kept getting stuck in previously.

I agree that it is frustrating when a therapist seems to be consistently pushing one toward a certain pattern of thinking - in my case it was because she could more clearly see the connection than I could.
posted by hilaryjade at 6:10 AM on April 13, 2018 [1 favorite]


I can't answer the EMDR yes/no question. I can say it helped a lot when I did trauma work, but I think it wouldn't particularly help me where I'm at now.

Instead, I have a few observations about life as a trauma survivor whose PTSD is officially considered in remission. -- I've found that people assume that trauma is the obvious goto when I'm experiencing issues, despite my claims or evidence to the contrary.

It feels like their thought process is "there's no why this person could have ADHD and be a trauma survivor at the same time. If we "fix" the trauma she'll be fine!"

I've had to develop scripts, like:

I know I probably sound anxious right now and that my speech has speed up. That's more because I have ADHD and anxiety over my ability to communicate effectively, then the situation we're discussing.

or

I get that past trauma is an obvious go-to when people complain about symptoms like mine, but I've had years of therapy and have been symptom free until last month. Unless there's an obvious connection that I'm missing, could we explore other reasons I'm feeling x?

My thought in posting this was that maybe figuring out a similar way to acknowledge what happened then and what you're experiencing now will be helpful in deciding what to do?
posted by bindr at 11:00 AM on April 13, 2018


I feel like EMDR is kind of a red herring here. Have you explicitly said to your therapist, "I feel like you are directing me to change the topic to past trauma every time we discuss present stressors. I want to spend more time in sessions developing coping techniques for the here and now, rather than trying to dig deep into why I'm feeling this way. Would that be compatible with the type of therapy you practice?" Remember that this is a relationship with a medical professional, and patient self-advocacy is your right (up to and including deciding this therapist is not for you).
posted by capricorn at 11:05 AM on April 13, 2018 [5 favorites]


I've tried EMDR and it didn't seem to do much for me, but I have only done a couple of sessions—I am keeping an open mind.

I have friends who have found it to be truly life-changing, although most of them have found it to help with anxiety issues stemming from past abuse. In that particular situation it apparently has a success rate that's as high as CBT.
posted by Kadin2048 at 11:30 AM on April 13, 2018


Just wanted to follow up after reading a well written response above.... my EMDR sessions did not include any kind of eye movement at all. There was a choice of headphones with alternating click in either ear or a sort of vibrating back massaging pad that alternated bursts of vibrations to either side of the spine. Others I've talked to spoke of being instructed to open and close their fists in an alternating way. I'm sure the eye movement is used by some EMDR practitioners, but apparently not all.
posted by Rapunzel1111 at 12:25 AM on April 15, 2018


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