Hacker News Reader

Comment by amelius | Hacker News Reader

Why not use EMDR instead?

https://en.wikipedia.org/wiki/Eye_movement_desensitization_a...

Purely anecdotal, but EMDR was not helpful for me. I’d heard many good things about it and had high hopes, but found it somewhat counterproductive. I think this somewhat depends on the nature of the trauma leading to the PTSD (e.g. a one time major event vs. complex trauma over an extended period).

I was dealing with the latter.

EMDR has been shown in many studies that it can be highly effective also for complex PTSD, see eg. a recent meta-meta-study ( https://doi.org/10.1016/j.janxdis.2025.103017 ). It very much and more depends on the relationship with the therapist, and how they integrate EMDR in a "complete" therapy. EMDR is a technique that can be used in many ways, not a full-fledged form of therapy.

I have a trusting relationship with a long term therapist, but they do not practice EMDR.

I saw someone who worked in the same practice for the EMDR sessions, but did not have the same depth of relationship with the EMDR practitioner, so maybe that was the issue.

I should mention that what ultimately changed the game for me in a major way was Ketamine assisted therapy as a supplement to my regular talk therapy.

After almost 10 years of weekly talk sessions, three Ketamine infusions was like jumping forward another 10 years in terms of processing/integration.

> improving outcomes for therapy-resistant PTSD patients.

You can use EMDR both for anchoring positive experiences, as well as to dip into unprocessed traumatic memories. In a typical therapy setting, you do both. Stabilization techniques are in addition to that; vagus nerve stimulation serves to calm down your nervous system, so it would aid the stabilization, so then in turn you can face more of the unprocessed trauma. It's not an either-or. PTSD therapy requires a combination of various elements, tailored to the specific circumstances, history and personality.

The idea to "try it at home" from some YouTube videos is absurd, unfortunately. It may do you good, OK, but it has nothing to do with real EMDR used in a therapeutic setting.

None of these treatments has a 100% success rate. You can try EMDR on Youtube and if it worked all the time, psychiatrists would be out of a job.

Not all licensed therapists or psychiatrists provide EMDR. Or did you mean psychiatrists specifically as they prescribe ssri’s?

Psychiatrists oversee treatment and give medication. They don’t do psychotherapy, so they are not in the business of offering EMDR. Easily confused but very distinct jobs.

Many psychiatrists only prescribe, some also do psychotherapy, and of those, some do EMDR. This is less common today than it used to be due to insurance and time and how they get paid, but some of those in private practice or academic settings still provide physiotherapy.

Sorry, I should a put a source: partner is a therapist.

Edit: autocorrect changed psychotherapy to physiotherapy.

Yeah I said it was dhit when my ex-wife said she was going to do it, but it definitely did something.

And I am well aware of the placebo effect.

But just because something is not provable or falsifiable under current scientific knowledge, it does not mean it is neccesarily quackery, there's a Venn diagram there where some things may be effective.

Automatically discarding something that even occasionally gets results, because it doesn't fit current "knowledge" is the height of arrogance.

Sadly it made my ex-wife worse off than before - she went from a functioning anxious person to being completely overwhelmed by anxiety all the time.

Unfortunate, the whole landscape on this is littered with mines and finding truly knowledgeable help is difficult, most seem to just push their favourite flavour, regardless of the patient.

Any successful form of trauma treatment will first make it worse, because you open the can of worms and begin to go deep. Unfortunately, many therapists are not very good at explaining that up front. If you only have a few sessions, it is basically guaranteed to make matters worse. That's a sign that it is working (but maybe a sign to switch therapist if it wasn't explained well and cautioned about; making sure the environment and person is ready for it should happen first...).

> But just because something is not provable or falsifiable under current scientific knowledge

Do you mean unproven instead of "not provable or falsifiable"?

Something not being falsifiable would mean that we can't detect if it's doing anything even if we tried, which doesn't bode well for its effectiveness.

From wikipedia:

EMDR has been characterized as pseudoscience, because the underlying theory and primary therapeutic mechanism are unfalsifiable and non-scientific. EMDR's founder and other practitioners have used untestable hypotheses to explain studies which show no effect.[55] The results of the therapy are non-specific, especially if directed eye movements are irrelevant to the results. When these movements are removed, what remains is a broadly therapeutic interaction and deceptive marketing.[52][56] According to neurologist Steven Novella:

    [T]he false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work.[57]

Possibly has placebo effect. I know someone who did EMDR and said it helped them a lot.

> because the underlying theory and primary therapeutic mechanism are unfalsifiable and non-scientific

Underlying theory doesn't matter much. Remember that we don't even know the mechanism of action of acetaminophen.

It may work, but there's essentially no evidence in the medical literature that it does.

It is one of the few forms of PTSD therapy where there is plentyful research about its effectiveness? In Germany, it is basically the only trauma processing technique covered by health insurance, because of its proven track record.

see e.g. Psychological interventions for adult posttraumatic stress disorder: A systematic review of published meta-analyses (2025) https://doi.org/10.1016/j.janxdis.2025.103017

State of the science: Eye movement desensitization and reprocessing (EMDR) therapy (2024) https://doi.org/10.1002/jts.23012

Instead of either/or why not try both?

Reply on news.ycombinator.com