Comment by thatsamonad | Hacker News Reader

Comment by thatsamonad | Hacker News Reader

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> EMDR

I’ve been undergoing EMDR treatment for PTSD and it is quite amazing how well it works. You wouldn’t expect that just watching something move back and forth in front of your face (or having an electric pulse alternate between your hands) in between talking about a traumatic experience would do much, but for me it’s been the most effective thing so far after trying many different kinds of therapy and medication.

I think what a lot of people need when it comes to depression/anxiety/trauma is not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away. A lot of our treatments focus on elimination rather than acceptance and reprocessing.

I think of it like short-term dieting vs lifestyle changes. The former may provide a quick fix, but the latter will usually be longer lasting, healthier, and easier to sustain after the initial push.

> not simply to feel better in short bursts, but rather to reframe and reprocess thoughts, feelings, and memories in such a way that they become easier to “hold” even if they don’t go away

This is absolutely the gist of it. Anything that helps you do something along these lines is worth pursuing. It's about building up scaffolding around a disaster area-- not to cut off access, but to put up a useful, multipurpose firewall.

I find it curious that on sufficient doses of MDMA ones eyes can rapidly go back and forth, similar to the EMDR process.

It’s funny that you say that. I’ve taken MDMA once in my life, and I swear it was one of the only times my mind didn’t feel like it was trying to attack me. I felt totally calm and at ease rather than high or euphoric. I haven’t done it again because I’m paranoid about addiction, but I could absolutely see it being effective as a tool for facilitating longer-term treatments. I’d jump at an opportunity to participate in a MAPS study or something similar in a controlled environment.

MDMA is fascinatingly effective. You get some hours of pure bliss, all your fears gone and replaced by compassion.

It should absolutely be treated as something very special - it 'just works'. Using it too often would make it loose it's magic (on a physical level too)

Then again most additions seem to happen with more subtle substances. MDMA is a way too powerful experience to do it casually.

There is very limited evidence that the bilateral stimulation has _any_ impact on treatment outcomes [0].

EMDR is PE with a marketing machine behind it. To quote Robert Ursano, a prominent figure in trauma research and treatment at the VA, “I concur with the view that what's new about EMDR is not helpful and what's helpful is not new,"[1].

There is a disturbing trend of EMDR being billed as a panacea by commercial training institutes without educating clients about equally or more efficacious treatments (PE, CPT) that are studied primarily in academic centres.

0: Chemtob et al., (2000), Davidson and Parker (2001) 1: https://www.washingtonpost.com/archive/lifestyle/wellness/20...

> EMDR is PE with a marketing machine behind it

What is "PE" in this context?

Googling suggests Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT): https://deploymentpsych.org/blog/staff-voices-pe-or-cpt%E2%8...

You are correct, but I think you are overlooking a peripheral advantage: (relative) fidelity to the model.

I have sent countless patients to therapists purporting to do DBT, CBT, PE, and others - only to review those sessions with them and hear about poorly delivered supportive therapy with questionable boundaries.

EMDR seems to be delivered with something approximating the actual therapeutic model as studied somewhere around 50% of the time. Which, sadly, is pretty good.

Can you elaborate on what you've seen as far as "questionable boundaries" is concerned?

I went to a licensed therapist who insisted I call my GP to obtain antibiotics for a cold. I explained to her that antibiotics arent effective on viral illnesses, she insisted that yellow phlegm indicates "an infection" this antibiotics would be effective. I am also anaemic due to a genetic condition, and the anemia is mild but basically untreatable. She suggested I look into treating it with "herbs."

That sort of boundary crossing?

I stopped going to her, obviously. Pisses me off i actually paid her.

That's not what I had in mind, but that is also a problem. What I meant by "questionable boundaries" is being more of a hired friend than a therapist, and talking about themselves and their own lives more than they should. Poorly trained therapists tend to take the side of the patient without exception, and rarely challenge the behaviors that can cause them problems. Therapy should feel challenging, and feel like work, at least most of the time. If it's someone telling you that you can do no wrong, that's not useful.

Thanks, you've put into words my somewhat bad experience with therapy.

Do you have any experience with Schema Therapy practitioners?

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