Acupuncture

TLDR: Acupuncture is said to be an ancient Chinese medicine, allegedly dating back thousands of years, where piercing the skin in key locations will change the flow of ki energy in humans, which can either harm or heal a person.

Red Flags

• Spirit Energy
• Ancient
• Alternative Medicine
• Buzzwords
• Mechanism is nonsense
• Quality Research shows “doesn’t work”

Origins

Practitioners often claim that acupuncture is over 4,000 years old. This is not true. At most, the basic Chinese theory is around 2,000 years old, and was inspired by the ancient Greek, Egyptian and Arabic ideas.

“Needling” was first demonstrated to the Wesetrn observer Willem Ten Rhijne, who worked for the East India Company, in 1680 by a Japanese practitioners (Acupuncture, Past, Present, and Future). Ten Rhijne described in a book he wrote and published 3 years later how the practitioner would hammer the ivory handle of a metal spike (The Western World’s First Detailed Treatise on Acupuncture: Willem Ten Thijne’s ‘De Acupunctura’). The earliest that an actual process referred to as “needling” found in China is from around 90 CE, but is talking about creating a sufficient puncture to blood let or to lance abscesses, using a large needle. (Science Based Medicine 1)

Rhijne observed that the placements of the punctures chosen by the practitioner were in accord to the humoural medicine theories of Greek origin. What Rhijne described did not involve qi et al, or any specific theory described to explain why the needles were placed where they were. He states that the gold needles were implanted deep into the skull or “bomb” and left in place for 30 respirations. Rhijne, 1683.

Indeed, Chinese scholar Paul Unschuld suspects that the practice likely originated with the Greek Hippocrates of Cos. Many of the Chinese practices such as burning and bleeding are adaptations of the ancient Greek, Egyptian and Arabic sources, which were recorded long before they were in China. The Silk Road spread ideas across Southern Europe, Northern Africa and Souther West to East Asia (Science Based Medicine 2). The earliest these ideas could get to China was round 200 BCE. Chinese medicinal texts often refer to practices that cause an incision or other skin penetration using the word zhen, which in modern times seems to always be translated to mean “acupuncture”, despite the context, and this was mostly in animal medicinal texts (A True History of Acupuncture).

The earliest account of Chinese Medical practices in Europe is dates to the 13th Century CE, in the travelogue of William of Rubruck (A True History of Acupuncture). It held no description of acupuncture. Escorial in Madrid, Spain, has a decription of “needling” from teh 16th Century CE, and shorlty after a few more descriptions of what might be recognisable as acupuncture. The earliest record of Acupuncture in the West was 1826 in USA, based on claims from Europe of success in resusitating drowned kittens by sticking needles into the kittens hearts. The Philadelphian physicians were unable to duplicate the results and “gave up in disgust”.

What we recognise to be acupuncture now is fairly new, as the technology to make thin needles is only around 400 hundred years old, so what we recognise to be acupuncture logically cannot be thousands of years old, it just refers to ideas that are thousands of years old (Science Based Medicine 2). That would be like referring to mondern western medicine as being thousands of years old, because doctors swear by the hypcratic oath, which is thousands of years old.

The earliest discovered descriptions of qi et al energy lines were discovered at the Mawangdui graves, sealed in 168 BCE and the Zhangjiashan burial site, closed between 186 and 156 BCE. These discuss mai, the imaginary ‘channels’ of energy that were associated with diagnosis and treatment. There is no needle or pressure involved in treatment (A True History of Acupuncture). The first mention of needling zhen (meaning to puncture to draw out fluid) dates 90 CE (A True History of Acupuncture).

In the 5th or 8th Century CE Huang Di neijing introduced some theoretical underpinnings of what likely became human acupuncture, that is the manipulation of qi flowing in vessels by means of needling – the reason for the uncertainty is that the texts themselves refer to the dynasties they were written in ambiguously. The copies written in the 11th Century CE were revised and so don’t actually give a fair reflection of the first editions history. It is speculated that in the Song Times, circa 960 to 1279 CE, the first prototype of what we would recognise as Acupuncture was described in the work of Wang Weiyi, re the acupuncture bronze man. However, the fine steel needles were not developed until the Qing times (1644-1911 CE). Throughout this time, acupuncture was a minor tradition, with most medical practitioners preferring herbal remedies (A True History of Acupuncture).

Writing in 1757 lamented the “loss of acupuncture tradition” and noted that the acupuncture points, channels and practices in use were very different from those described in the “ancient texts”. This shows that both the practice from its theoretical earliest time of using thin needs was poor, and that the actual practice of those who did do it was poorly adherent to what was supposedly supposed to work. China attempted to ban the use of acupuncture in 1822, and several times afterwards by the Qing government who banned the teaching of acupuncture since it was shown to not work. Japan prohibited hte practice in 1876. (Forgotten Traditions of Ancient Chinese Medicine).

Chairman Mao Zedong promoted acupuncture and other forgoten and abandoned traiditional medical techniques in the 1950s as part ofhis Great Leap Forward, as a pragmatic solution to providing health care of the vast Chinese populatin by the undersupplied medical doctors, who were at the time predominantly using the Western Medicine style since it was shown to be effective, while most of the traditional herbal and other traditional Eastern medicine was not. Chairman Mao knew he couldn’t afford the Western Medicine supplies and so needed something home grown to appease the population. Chariman Mao refused to receive any of these traditional remedies, which I feel is quite telling. (Forgotten Traditions of Ancient Chinese Medicine).

Mechanism

The Acupuncturist will insert needles into specific Acupoints, allegedly triggering a physiological effect particular to that point. Three methods may be used to locate acupuncture points – the anatomical landmark method, the proportional bone (B-cun or skeletal) method, and the finger–cun (F-cun) method (aka the directional method). The anatomical landmark method is considered to be the most accurate method, but can only locate 361 acupuncture points along 14 [meridian] channels. (Accuracy and Precision in Acupuncture Point Location: A Critical Systematic Review, 3 November 2018).

Meridian is a term for where the spirit energy called chi, ki, qi, mai or other various names, flows. The idea is that free flowing spririt energy is what gives a person health, and when this spirit energy doesn’t flow freely, it will cause discomfort and disease. Georges Soulie de Morant, was the first to use the term “meridian” and to equate qi with energy – in 1939. Auricular (ear) acupuncture was invented by a Frenchman in 1957. Prior to this, acupuncture attempst in the West inserted needles close to the point of pain. (Puncturing the Acupuncture Myth, 21 October 2008)

Originally there were 360 acupuncture points, based on the days of the year), effectively linking the points to Chinese Astrology. There are now over 2,000 points due to additional “discoveries”, with the specific number depending on which kind of acupuncture you subscribe to – Chinese, Korean, Japanese or some variant. There are between 9 to 11 meridians or channels that the spririt energy travels, with potentially hundreds of sub channels, again depending on which variant you subscribe to. It has been quipped by some skeptics that it is hard to insert a needle into someone without hitting an acupuncture point, making sham treatments in tests difficult. (Puncturing the Acupuncture Myth, 21 October 2008)

There is no specific explanation given to why metal needles would free up the spirit energy, how deep to push the needles, or how long to keep them there. Each practicioner defines that for themselves.

Does it work? (No)

To determine if a model works, you need to test it. With different versions of acupuncture having different acupoints and different meridians, with the depth and duration determined by the practicioiner, it is hard to tell if the reason why it does not work better than a placebo in trials is because the wrong acupoints were used or some other vague error. Papers have been released on how well acupuncture workds, however the quality of these studies is poor and they are published by practitioners who promote acupuncture.

Many scientific examinations of this have been performed. A few of these tests have shown that acupuncture works better than chance and better than the placebo effect. Acupuncturists state, therefore, that acupuncture is Evidence Based Medicine.

The problem with this claim of Evidence Based, is that most of the evidence says it doesn’t work.

Acupuncturists refuted scientific assessments of acupuncture by asserting that the unbiased scientist didn’t compare sham acupuncture (random placement of the needles) with real acupuncture points. In an American study, recognised acupuncture specialists were brought in to instruct the testers on where the real acupuncture points were. These leading practitioners disagree with each other about where these acupuncture points are, yet state that there version consistently works and is the only model that is true. (Accuracy and Precision in Acupuncture Point Location: A Critical Systematic Review)

• If where you insert the needle doesn’t matter, then it isn’t acupuncture, it is just stabbing you and why do we call it “traditional medicine” or “alternative medicine”.
• If it does matter, then how can there be many systems of “real” with the statement that the other expert’s location is a sham?
• When setting up a trial for acupuncture, trying to compare “real” versus “sham” puncturing is impossible when there is no agreed upon definition for “real”.

Even so, scientists have tested most of the leading versions of “real” and found that they consistently give the same result as the sham, which is often no greater than the placebo effect (where you think you are better because you got treated, regardless of whether the treatment was real or not).

Medical scientists have attempted to look for qi, meridians or any other potential physiological mechanism that may exist without any success. With so many potential acupoints, some do overlap actual medically interesting points on the body, however this is like spraying paint on a map of the world and being astounded that some of the drops overlap cities. There are many acupoints that hit nothing of medical interest, and when a needle is applied, not noticeable medical change occurs.

That is, no, it doesn’t work.

Where is the Harm?

There is a risk of direct harm if the needles are not properly cleaned between uses, as it is possible to spread disease. Another direct physical harm can occur if the skin that the needs is going to be applied to is not properly cleaned – the microbiome that covers us is farmed to protect our skin, but can be harmful if pushed inside our body. This is quite a bit of risk with no consistent medical evidence of gain.

The less direct harm is that you are spending money on a treatment that has failed to demonstrate any evidence of consistent benefit when tested against a control better than a placebo. If you’d like to try a placebo treatment, eat a few grains of sugar. This fake treatment can delay you seeking proper medical attention if your condition is serious, which can lead to poor results including death. If your condition is serious, why are you paying a sham practitioner to perform a sham treatment on you?

Summary

• Acupuncture relies on unblocking spirit energy that is supposed to flow through your body. No scientific study has ever found this spirit energy.
• Acupuncture and its relatives (acupressure, acupoints etc) has been thoroughly studied. The studies have gone out of their way to factor in the criticisms from acupuncturists. They found no consistent positive effect.
• Acupuncturist leaders disagree with each other about where the acupoints are, while at the same time stating that their system is the only system that actually works.

Chiropractic

Chiropractic is faith healing through bone manipulation, invented by D. D. Palmer, Sep 18, 1895. He claims that he adjusted the spine of a deaf man and allegedly restored his hearing. From what we know of from modern medicine, this is a very implausible claim.

Red Flags

• Purple Hat Therapy
• Spirit Energy [Innate Force]
• Mechanism is nonsense
• Alternative Medicine
• Quality Research shows “core Chiropractic doesn’t work”

Origins

Daniel David Palmer performed a spinal adjustment on a partially deaf janitor, Harvey Lillard in 1895. Palmer alleges that he noticed that when Lillard bent over to empty a trash can (without his shirt on), Palmer noticed that a vertebra was out of position. Palmer queried Lillard on this, and Lillard allegedly stated “I moved the wrong way, and I heard a ‘pop’ in my back, and that’s when I lost my hearing” (Source). Palmer was involved with many “natural” healing philosophies, asked Lillard to lie face down on the floor and adjusted the vertebra back into place. Allegedly Lillard informed Palmer the following day that he “can hear that rackets on the streets”. This led to Palmer to open a school of chiropractic 2 years later. The term Chiropractic was coined by Samuel H. Weed, from a portmanteau of the ancient Greek words cheiro (hand) and praktikos (action, to do). (Source)

Palmer explained his method as part of vitalism (life energy), naturalism, magnetism and spiritualism. As science improved and showed that none of these health ideas were valid, Palmer did try to merge the new science with metaphysics with a key phrase “a science of healing without drugs”. The original Principles of Chiropractic mimicked Andrew Still’s Principles of Osteopathy (established a decade earlier). Palmer’s Chiropractic was mostly a copy of Osteopathy, with Still referring to chiropractic as a “bastardized form of osteopathy”. Still suceeded in passing a law for licensure, which resulted in Palmer and other chiropractors being jailed for practicing medicine without a license (Source).

The modern Principles of Chiropractic have 33 statements, most of which are nonsense and still rely on vitalism, which was shown to be medically and scientifically invalid even in Palmer’s era.

Mechanism

Chiropractic (that is the right grammar) relies on the 33 Principles of Chiropractic. These are non sensical statements that approximately equate to faith healing, attempting to reverse the interreference of life forces by adjusting dislocated bones along the spine.

TLDR:

• These are the 33 Principles of Chiropractic.
• They are all about defining the world in a very weird way, often contradicting itself.
• The only part about “healing” is clauses 28, 29, 30 and 31, which effectively say that “disease is caused by an interference in the transmission of innate force [chi type energy] from subluxation [dislocation] of the spinal column”.
• There is zero evidence that there is such an energy / force in humans, and zero evidence of dislocated bones along the spinal column for the vast majority of people who receive a spinal adjustment from a chiropractor.

Science Based Medicine reports that there is no credible evidence to support the claims of the above principles for their practice, and no evidence that adjusting the bones of the spine, or anywhere else, give any reliable medical therapeutic treatment to the vast majority of the diseases that Chiropractors claim to treat.

We can divide Chiropractic practitioners into 3 categories:

1. Straight practitioners, who only adjust the spine
2. Mixed alternative medicine practitioners, who include other pseudoscience treatments like acupuncture, kinesiology etc
3. Mixed with physiotherapy (and probably the pseudoscience treatments)

Does it work? (no)

When studying the efficacy of chiropractic, the chiropractors that show consistent positive results are in the third category, those who mix in physiotherapy treatments (Purple Hat Physiotherapy). However, chiropractors rarely have a degree in physiotherapy and so are not technically qualified to do physiotherapy treatments.

When studying the efficacy of the pure chiropractic interventions, no reliable positive results occur, indicating that it is an ineffective treatment.

Where is the Harm?

The risk is high for very little reward.

There is a slight chance that with a spinal adjustment you can be paralysed or have a stroke. Many people have had strokes after a spinal adjustment. As many countries now allow chiropractic as a health treatment, the investigation and punishment of malpractice is generally handled by a chiropractic board of chiropractors, who somehow find that the larger than average number of post treatment strokes (when compared to the background number) were all due to pre-existing problems, or from some incident that occurred after that adjustment. (Source)

This is a serious risk of injury for no consistent proven benefit for the adjustment – all risk with no gain.

Summary

• This risk analysis effectively says “pay money for a treatment that can kill you with zero reliable evidence that this treatment will help you”.
  • Purely chiropractic treatment is faith healing with zero evidence that it works.
  • The only reliable treatment that Chiropractors give is physiotherapy, which most are not qualified to give. If you want physiotherapy, go and see a physiotherapist.
  • There is a risk of paralysis or stroke, which is a serious consequence, without any evidence of reliable positive results.

Emotional Freedom Technique (EFT)

EFT, aka tapping, is a method that combines tapping on acupuncture (acupressure) points with focusing on a specific mood issue. The process creating a “setup statement” or self-acceptance for a problem, rating distress before, during and after, and then repeating the statement while gently tapping on a sequence of points on the face and body until the distress level decreases.

Red Flags

• Spirit energy
• Ancient Technique claims
• Mechanism is nonsense
• Quality Research shows “core EMDR doesn’t work”

Origin Story

In the 1970s and 1980s, several doctors, Dr George Goodheart, Dr John Diamond and Dr Roger Callahan, independently began stimulating acupressure points of peopled who verbalised their stress, fear and phobias, and found that their stress decreased. Dr Roger Callahan patented one of these methods, Thought Field Therapy (TFT). Dr Callahan’s processes evolved and became quite complex, leading to people finding it difficult to remember what to do to get good effects. Gary Craig, a student of Dr Callahan and engineer, simplified the process and introduced it to the public as Emotional Freedom Technique (EFT) in the late 1990s. (Source 1, Source 2)

But does it work? (No)

Mechanism

The stated mechanism for EFT is to tap on acupuncture points to stimulate the bodies natural spirit energy field which will heal your mind and body without the use of medications. Some EFT websites claim that this makes EFT an ancient technique.

As covered in acupuncture, these energy fields and channels doesn’t exist and has been thoroughly debunked.

Apologists for EFT try to cite that tapping on these points has been measured to release biological chemicals that are good for relieving distress, but there is zero evidence of this being true either.

(Source 1, Source 2)

Quality Research

Research into EFT has often been done poorly. If EFT has a real positive effect, it shouldn’t be hard to show some quality studies with positive effects, and the lack of this is generally a red flag of pseudoscience.

For example, this meta analysis compared 7 EFT trials to RCT (Randomised Control Treatment), in this case the control was EMDR (1 study) or CBT (1 study), and waitlist (5), and found that all three were equally helpful. While that sounds good, the devil is in the details.

We have covered that EMDR is a sham, unless it incorporates TF CBT, in which case it is TF CBT with a Purple Hat. This study did make it clear whether the comparison CBT study was regular CBT or Trauma Focused CBT (TF CBT).

There were 7 EFT studies used in this meta review, as they met the criteria for comparison to an established PTSD treatment (according to APA Division 12 Task Force), EMDR and CBT. Since only two trials included these two treatments, the other 5 were compared to waitlist (which is no treatment). This isn’t a robust comparison, risking any noise or other oddity to significantly bias the outcome. It is also concerning that this meta study could only find 5 studies of EFT that met the standards of he APA Division 12 Task Force, which despite the body of evidence showing that EMDR is a sham or purple hat version of TF CBT, still listed EMDR as a good treatment for PTSD. We do not know how many EFT studies were discarded, and that is a detail that should have been reported.

This meta analysis does not indicate whether the EMDR trial was recent or old, so we don’t know if we are comparing EFT to a rebadged TF CBT or a sham. It also doesn’t clarify if the “CBT” was “TF CBT” or just regular CBT, which is not the gold standard. The lack of TF implies it is likely regular CBT.

The lack of specificity and the unstated number of trials discarded makes this meta analysis useless.

The meta study states that no adverse effects were noted by EFT during the trials. It did not make it clear if the people were followed up in 3 months, 6 months and 2 years to see what had worked, since an initial boost to feeling good is part of the “treatment effect”. The lack of inclusion of this information implies it likely didn’t. Nor did it make it clear if the people also received medication treatment as well (which should be part of standard treatment).

A meta study that only includes 2 actual trials (versus EMDR and CBT) is not really an effective meta study, and that wasn’t made very clear in the brief. A large treatment effect was noted compared to those on the waitlist, which is likely just the “treatment effect”. Therefore, the study’s conclusion that EFT was as effective as EMDR and CBT when supplied with 4-10 sessions of EFT is not actually a result that I have confidence with.

If EFT was an effective treatment, we wouldn’t have low quality studies being massaged to look like a positive effect.

This study was affiliated with the Transcendence Institute, which is interesting. While it is usually bad form to judge a book by its cover, the transcendence in the institutes title suggests that these people are likely pro alternative medicines, so they were highly motivated to show that their treatment has merit. That is, they were unlikely to be trying to sabotage EFT, rather they were motivated to show EFT at its best. Unfortunately, the best they could do was to create this awful flawed study, comparing EFT to people on the waitlist (5 studies), EFT to EMDR (unspecified if just a sham or the modern TF CBT clone) and CBT (unspecified if regular CBT or TF CBT), no specification of if the participants were given medication to help treat symptoms or not, with no follow up on whether participants had continued positive results after 3 months, 6 months and 2 years. The best evidence the the Transcendence Institute could present was a terrible flawed study. If quality good studies existed, why didn’t the Transcendence Institute use these?

When you have to lie to make your point, you don’t have a point.

Where is the Harm?

EFT may be useful to distract someone from a mild anxiety or panic attack. It has no actual therapeutic value beyond this, which can delay proper diagnosis and treatment. EFT is mostly used for anxiety, phobia and PTSD. Anxiety and PTSD is a high risk group for self harm and death by suicide.

A delay in treatment can risk misdiagnosis, poor medical treatment and exacerbate instability. Instability in a high risk population can lead to serious harm and death. EFT increases risk without providing any realistic relief or improvement.

Summary

• EFT can bring more temporary relief than being on a wait list, but has yet to show efficacy in any quality research
• Relying on EFT as the basis for therapy is risky in a high risk group.

Eye Movement Desensitisation Realisation (EMDR)

TLDR: EMDR, started as pure pseudoscience and has now become an expensive Purple Hat Therapy. The unique thing about EMDR from TF CBT is the eye movement while talking about trauma, and this has failed to show any improvements alone on the gold standard treatment, TF CBT (for Trauma).

EMDR is supposedly a method of managing traumatic or disturbing thoughts via saccadic eye movement. An alternative to saccadic eye movement is tapping your hand (aka Emotional Freedom Technique, another pseudoscience). Proponents cite that a benefit of EMDR is that you don’t have to discuss or disclose your traumatic memories and experiences, while the Australian Guidelines for PTSD state that now that modern EMDR incorporates CBT elements in its therapy, it has now got about as good as TF CBT, and is effectively no different to Trauma Focused Cognitive Behaviour Therapy (TF CBT) where you do actually explore memories, while wiggling your eyes, however the Eye Movement component has zero evidence of effectiveness.

Red Flags

• Purple Hat Therapy
• Buzzwords / Psycho babble
• Mechanism is nonsense
• Quality Research shows “core EMDR doesn’t work”

Origin story

The usual origin story is that EMDR was invented by Francine Shapiro in 1987 while she was taking a walk in a park [Revisiting the Origins of EMDR, 2023]. Shapiro states that she realised that she was able to cope better with disturbing thoughts when she used saccadic eye movement. Saccadic means to rapidly move your eye to different points. Shapiro noted that she was looking at the trees on either side of the path, disturbing thoughts rose and disappeared without intentional effort. Shapiro states that when she specifically considered those thoughts, they seemed to be no longer upsetting.

However:

In 1985 during Shapiro’s fourth year of studying Psychology, two years prior to her stated origin story, Shapiro published a paper in Holistic Life Magazine discussing theories on various topics about NLP (Neuro-Linguistic Programming – another pseudoscience), and the importance of eye movement patterns. In this, Shapiro makes it clear that despite her fourth year studying of psychology, she does not understand the concepts of “scientific” and reliable. She states “In other words, Neuro-Linguistic Programming is scientifically rather than merely theoretically based.” Publications at the time showed the NLP was not consistently replicable – a cornerstone of “scientific”. Additionally, the claims made by NLP practitioners is wild, clear signs of pseudoscience.

It was revealed in 2014 by B. Grimley in his article Origins of EMDR- a question of integrity? that while she worked for Grinder in administration, John Grinder had asked Shapiro to use an NLP technique to assist a friend who had been sexually assaulted, to put them into a “resourceful state” via asking her to “systematically move her eyes through the various accessing positions typical of the major representational systems”. “You may imagine my surprise when I later learned that she had apparently turned these suggestions into a pattern presented in an extended training, with no reference to source, with a copyright and a rather rigorous set of documents essentially restricting anyone trained in this from offering it to the rest of the world” stated Grinder.

Mechanism

Early EMDR had patients think about their distressing thoughts while doing the saccadic eye movements, latter with tapping or finger clicking. EMDR proponents claim that EMDR works by using bilateral stimulation (saccadic eye movements, tapping, etc), while a person recalls a traumatic memory. This allegedly helps the brain to reprocess the memory similar to REM sleep, with the expectation that this can reduce the memory’s emotional intensity; transform negative beliefs about the trauma; and help integrate the experience into a more adaptive, less distressing memory. This riffs off the ideas of NLP which have also been discredited.

Later EMDR patients were also given some fundamental TF CBT (Trauma Focused CBT) elements, sometimes completely copied, sometimes rebranded with odd names and descriptions.

So far there is zero evidence that any of the mechanisms have any scientific credibility beyond an initial hypothesis. If you consider that research has not supported these claims, since the results of EMDR are poor in rigorous studies, the proposed mechanism is both nonsensical and likely false.

Does it work? (no)

Shapiro’s explanation for why EMDR works is filled with neurology babble, words that sound like science, but don’t mean anything or make any actual neurological sense. Often a red flag for pseudoscience.

Many of the research papers for EMDR should not have passed peer review. For example, many of them have no control group (like this one), is unblinded (therapy versus medication) or is compared to no treatment (like this relaxation or therapy one). Modern EMDR research is confounded due to the recent inclusion of CBT style practices in the EMDR training, effectively comparing EMDR+CBT with CBT, and finding them about the same level of effectiveness. That is the very definition of a Purple Hat Therapy.

In my opinion the these two particular paragraphs from the Australian Guidelines for the Treatment of Acute Stress Disorder & Posttraumatic Stress Disorder, 2013 are very pertinent.

Indirectly, the harm is delayed treatment and often misdiagnosis. Most people turn to EMDR because they have been told it is a quick, easier, less invasive treatment for Trauma. Most people who seek EMDR don’t have PTSD or a Trauma led condition, we cover Trauma Myths here. If you really are experiencing PTSD, then you will need to come to terms with your experience rather than just pushing them under the carpet, and if that is the case, then you really should use the proper treatment for it, not a cheap knock off TF CBT.

Delayed treatment for your actual condition, or erroneous therapy for PTSD, can cause severe instability, which risks self harm and death by suicide. That is quite substantial consequences, far worse than the loss of your finances in seeking treatment that is often wrong and a poor imitation.

Summary

• The risk analysis is that EMDR is an expensive Purple Hat Therapy for actual TF CBT
  • EMDR delays quality treatment, which is TF CBT + Medication
• Risks
  • High risk of misdiagnosis
  • Risk of unstable results, leading to self harm and or suicide

It is cheaper and wiser to put your dollars to proper TF CBT than to pay for the premium Purple Hat + second rate TF CBT.

Schema

Schema Therapy, created by Dr Jeffrey E. Young, is an integrative psychotherapy combining original theoretical concepts and techniques with those from pre-existing models, including Cognitive Behavioural Therapy (CBT), Attachment Theory, Gestalt Therapy, Constructivism, and Psychodynamic Psychotherapy. It has four main concepts: Early maladaptive schemas (aka schemas), Coping styles, Modes and Core emotional needs.

Red Flags

• Purple Hat Therapy
• Buzzwords / psycho babble
• Mechanism:
  • Explanation for why ill health is now considered false
  • Therapy is a synthesis of 5 therapies, CBT (which is good) and 4 other dubious or discredited ideas
• Quality Research shows “a weak positive effect”, but this is a very weak signal considered how much of the research is not acceptable.

Origin Story

Schema Therapy was developed by Dr Jeffrey E. Young. According to the AIPC Schema Therapy: Origin, Definition and Characteristics, Dr Young was working at the Centre for Cognitive Therapy at the University of Pennsylvania, when he identified a portion of clients who saw minimal benefit from “the standard approach” of talking therapy. He noted that these clients had long standing patterns or themes in thinking, feeling and behaving / coping that required a different means of intervention. In his research paper “Cognitive therapy for depression”, 2001, the optimistic view for treating Major Depressive Disorder (MDD) with antidepressant medication or CBT is at most 60% during the acute phase, and when followed up 1 year later, 30% of those treated with CBT only had relapsed into major depression and 60% of those treated with antidepressant medication only had relapsed.

Young developed the Schema Therapy paradigm primarily for the treatment of personality disorders and other chronic conditions such as long-term depression, anxiety, and eating disorders. Many therapists consider these disorders to be too complex or resistant to treatment to address, so Young’s therapies that specifically focus these seemed welcome.

Schema therapy is often utilized when patients relapse or fail to respond after having been through other therapies (for example, traditional CBT, medication etc).

Schema has 5 base therapies that inspired it:

• CBT (Cognitive Behavioural Therapy) is the gold standard therapy and works for pretty much everything if done properly for that condition (where talking therapy can work) and gets best results when used in conjunction with medication
• Attachment Theory is very useful when working with children before they have good language and cognitive function, and mostly useless for adults
• Gestalt therapy is lovely in theory, looking at the whole person and their networks, but unfortunately, almost none of that is used by therapists
• Constructivism is a lovely theory about learning and being active in learning, which is already inherent in CBT.
• Psychodynamic Psychotherapy is mostly psychobabble. It had an interesting aspect of recognising that not all of our brain’s functions are directly available to our conscious reasoning, but after that is became almost magical thinking with no evidence of fact.

But does it work? (No)

Mechanism

Young proposed that what DSM IV TR called Axis 1 Disorders, such as major depressive episode, schizophrenic episodes, and panic attacks, and Cluster B, the Personality Disorders (especially BPD), were caused by toxic early childhood experiences, aka childhood trauma. He called these “Early Maladaptive Schemas” (EMS) and defined them as:

• A broad, pervasive theme or pattern
• Comprised of memories, emotions, cognitions and bodily sensations
• Regarding oneself and one’s relationships with others
• Developed during childhood or adolescence
• “Elaborated” throughout one’s lifetime
• Dysfunctional to a significant degree
• [Source: AIPC Schema Therapy: Origin, Definition and Characteristics]

That is, your toxic early childhood experience -> early maladaptive schemas (early poor conceptions of the world) -> maladaptive behaviours -> reinforced throughout your life. Schema Therapy seeks to address the EMS to fix the root problem.

We are now aware that many of the disorders are biological in nature (Therapies, Understanding Mental Health, Neurodivergence). Trauma can be a primary root cause, but this is quite rare despite the ongoing dogma otherwise. Conflict and Toxic People can be an exacerbator of existing issues, a temporary problem on its own or in extremes, the source of trauma.

Mechanistically speaking, the hypothesis that these complex conditions are caused, at their root, by childhood trauma is wrong. While the proposed method to address this hypothetical aetiological cause of complex mental ill health has a level of soundness (CBT), the other concepts brought in to try to correct maladapted schemas, coping styles and modes to address core emotional needs, is founded on defective therapies. The fact that the hypothesis (EMS cause) is wrong means the proposed solution is likely faulty.

Schema Therapy generally fails, The few gains people make are due to the CBT component of Schema Therapy, which puts it in the category of a bad Purple Hat Therapy.

But what if Young happened stumble upon something that worked despite the massive flaw in his hypothesis? What does the evidence show?

Quality Research

I think this meta study (2021) has a salient point when it examined 316 studies and found only 41 that “could be included despite lenient methodological inclusion/exclusion criteria. Results showed that schema therapy can lead to beneficial effects in disorder-specific symptoms and early maladaptive schemas. Yet, we also uncovered substantial methodological limitations in most studies.” My bold and italics, not theirs. Despite this, the meta study concluded that “Schema therapy is a promising treatment for anxiety, OCD, and PTSD. Yet, there is a systematic problem in the quality of research despite growing clinical interest and application.”

I am not sure how they concluded that it is a promising treatment from that.

An earlier meta analysis (2015) examined 3200 abstracts, and discarded most of them. A total of 9 met the remained after the exclusion criteria and quality criteria were applied to assess if Schema Therapy was helpful for Personality Disorders. That is quite a culling of studies. Granted, some of the studies were for trying to treat conditions that were not personality disorders, but for only 9 to meet the criteria to treat PD and be of a high enough standard is damning, considering that PD was one of the primary disorders that inspired Young to develop Schema Therapy. The conclusion section briefly discussed how bad the other studies were and gave recommendations for how to improve Schema Therapy studies moving forwards. In the discussion section, a semi positive statement “Although their findings are preliminary, favorable results were reported for the application of ST in a difficult-to-manage population including patients with antisocial personality and high psychopathy scores.”

If meta studies are finding it this difficult to find quality studies, and the ones that pass the criteria only have an indication that there may be some good aspects to the therapy, then it is fair to say that this does not consistently work. That is, the research is very poor, and the results of the few studies that weren’t horrible were weak. If Schema Therapy worked and was effective, then it would be easy to show in good quality research.

Where is the Harm?

People who have complex mental health, such as major depressive episode, schizophrenic episodes, panic attacks, and ‘Personality Disorders’ do not need a therapy that promises to help them, which not only fails to provide a valid mechanism of why these people struggle, it uses known flawed psychological remedies to try to address it. This is exploitation of the vulnerable. Therapists have often been fooled into thinking that this is a valid therapy method and have failed to look at the actual research into how effective Schema Therapy is. Erroneously leaning into the trauma narrative makes it very hard for people to address actual biological problems and relearn better coping and thriving strategies for what remains.

The suicide rate for these conditions is high, the quality of life for those who do not kill themselves is low. They do not need yet another exploitation or false promise of help.

Summary

When Young proposed his ideas for addressing what he thought was the root cause of some complex mental ill health, his logic was sound for the time and the therapies he meshed together were also considered mostly sound at the time. Unfortunately, we now know that his proposed reason for complex mental ill health is wrong and the therapies that he meshed together are mostly flawed. Research into Schema Therapy effectiveness shows grossly incompetent studies are the norm, and the tiny percentage that were passable showed only a small, limited, positive gain.