Why can’t RAMCOA patients access effective treatment?

Intensive, individually tailored trauma-informed treatments are unavailable within the public sector, which is critically understaffed and prioritises crisis management and behaviour modification (Murray, 2017; RANZCP, 2024; Winkler et al., 2023). Therefore, EMDR remains inaccessible to the low-income disabled patients who need it most. Instead, they are subjected to several CBT sessions, typically administered by young graduates with zero specialist trauma training and no lived experience.

‘Trauma-informed’

Siegel (2015) defines integration as a process by which trauma engrams are moved from implicit to explicit memory, thereby facilitating affect regulation. Trauma is encoded through images and sensations rather than words or cognitions because the brain regions responsible for language (including Broca’s area) are effectively offline both during the traumatic event and when reliving the incident (Gantt & Tripp, 2021; van der Kolk, 2001). This explains why PTSD sufferers struggle to discuss what happened.

Body memory is an implicit memory form that unconsciously influences behaviour, sensations, and emotional responses to certain cues (Gentsch & Kuehn, 2022). Rather than engaging language and cognition, effective trauma therapies focus on bodily sensations and emotions; they employ techniques such as bilateral stimulation (BLS) to facilitate brain integration (Macaulay & Angus, 2019; Tripp, 2021).

Cognitive behavioural ‘therapy’

CBT is a method of developmental trauma denial developed by MK-Ultra psychologist Aaron Beck in the 1960s. It was introduced to Australia by MK-Ultra perpetrators Antony Kidman and Martin Seligman. Seligman designed the CIA torture program. He also helped pioneer the 70s research in which toddlers – not animals – were electrocuted on metal grids until they dissociated. This phenomenon was originally called “inescapable shock” but was later renamed the more palatable “learned helplessness.” These monsters introduced and promoted CBT specifically to prevent their victims from engaging in effective treatments that threatened to expose their crimes.

Foa et al. (2013) identified CBT’s mainstream advantage: “…therapists without prior CBT experience can readily learn and implement the treatment successfully.” Hence, CBT is systematically and thoroughly taught in every Australian university psychology and psychotherapy clinical training program. CBT is typically delivered within 12 sessions, making it cost-effective. These factors make CBT highly accessible.

However, CBT was falsely established as a gold standard trauma intervention (Shedler, 2018). Loosely pioneered by Ehlers and Clark (2000), TF-CBT encompasses any therapy that uses CBT to treat trauma. A standardised TF-CBT protocol does not exist (Mavranezouli et al., 2020). For example, to compare TF-CBT to EMDR, researchers must design their own ‘ad hoc’ CBT protocol (Santarnecchi et al., 2017).

CBT is premised on the idea that human emotions are mainly caused by distorted thinking rather than traumatic events (Beck & Beck, 2020). CBT uses cognitive reasoning and behavioural modification to (unsuccessfully) impact amygdala-mediated conditioned fear responses. CBT mandates engagement of explicit and cognitive brain networks, notably the hippocampus and PFC, which are dysfunctional and unavailable in PTSD brains. Consequently, trauma-related disorders are unresponsive to cognitive-behavioural learning models (Spinazzola et al., 2018; van der Kolk, 2005; van der Kolk et al., 2019). Van der Kolk openly derides CBT as ineffective and harmful to clients with developmental (especially pre-verbal) trauma histories.

Further, “Affect regulation is not a primary focus of current CBT approaches for PTSD” (Brown et al., 2018). Since trauma exposure without emotional regulation is retraumatising, and affect regulation is not part of the CBT protocol, CBT is a potentially harmful treatment for trauma survivors.

Numerous randomised controlled trials (RCTs) have reported that TF-CBT is efficacious (Ross et al., 2021). However, the effect sizes reported by these studies are likely overestimated due to publication bias (Cuijupers et al., 2010). This bias is demonstrated in a meta-analysis comparing the efficacy differences between EMDR versus TF-CBT (Mavranezouli et al., 2020). In this meta-analysis, each EMDR study contributes to the overall mean. However, high variability (indicated by larger standard deviations) resulted in wide confidence intervals. This limits the conclusions we can draw about EMDR’s efficacy.

By contrast, TF-CBT, which is supported by more studies with lower variability, shows narrower confidence intervals and more reliable mean estimates. The overlapping confidence intervals suggest no clear difference in efficacy (see p. 550, “Further research is needed…”). Since EMDR and TF-CBT were first evaluated in RCTs in 1989 (Shapiro, 2014), this suggests the difference in study volume is not due to TF-CBT research commencing earlier than EMDR research, but to a systemic bias favouring TF-CBT research funding and publication from its inception.

Decades of meta-analyses suggest that different psychological therapies yield similar outcomes, despite their disparate theoretical and methodological underpinnings. Budd and Hughes (2009) argue that this flawed conclusion stems from the inappropriate use of RCTs to compare diametrically opposed treatments, such as CBT versus EMDR.

Regardless, a translational gap has been identified between CBT efficacy as measured in research settings and that demonstrated in clinical practice (Foa et al., 2013; Murray, 2017; Pfeiffer et al., 2024). This gap is commonly dismissed by attributing it to challenges in disseminating and implementing CBT training – a conclusion inconsistent with how CBT has been systematically, thoroughly, and exclusively taught in every Australian university for decades.

Eye Movement Desensitisation & Reprocessing

Unlike CBT, Shapiro’s structured EMDR protocol was specifically introduced to address intrusive trauma memories (Dyck, 1993). EMDR combines relaxation techniques, bilateral stimulation (BLS), mental imagery, and rhythmic repetition of movement. Multiple sensory systems (tactile, visual, auditory) are simultaneously activated during EMDR, thereby providing optimal engram reactivation.

BLS in EMDR has various delivery options (De Jongh & Hafkemeijer, 2024). Eyes-open EMDR uses a light bar or the therapist’s hand movements across the visual field. In eyes-closed EMDR, the therapist taps the client’s hands or thighs. BLS can be self-administered via ‘butterfly’ taps, handheld pulsators, or auditory tones.

Mechanism

There is no consensus regarding EMDR’s mechanism of action (Landin-Romero et al., 2018). Here are some proposed explanations for its effectiveness:

1. According to Shapiro’s (2018) Adaptive Information Processing theory, trauma memories are stored as visual, somatic, and emotional fragments. EMDR helps access and integrate these fragments (Baptist et al., 2021).

2. Bilateral saccadic eye movements and tactile stimulation enhance memory retrieval and emotional regulation by stimulating interhemispheric communication (Lee & Cuijpers, 2013; Nieuwenhuis et al., 2013).

3. Saccadic eye movements down-regulate the amygdala (Maeda et al., 2020).

4. BLS trigger the orienting response, a natural reflex to novel stimuli, which calms the client during trauma reexperiencing and helps extinguish the emotion attached to trauma memories (Landin-Romero et al., 2018; Pagani & Carletto, 2017).

5. The relaxation response may also be caused by EMDR stimulation of the vagal nerve via the oculo-cardiac reflex, which slows the heart rate, calms the body, and relieves anxiety (Corrigan et al., 2015; Bowen, 2008).

6. Sensory stimulation during EMDR deactivates the anterior cingulate cortex (ACC), which facilitates cognitive processing, reduces emotional reactivity, and reduces PTSD symptoms (Landin-Romero et al., 2018). Neuroimaging supports this idea. In one study, 73% of participants with adult-onset PTSD recovered permanently after EMDR, and showed increased PFC, basal ganglia, and ACC activity (van der Kolk et al., 2007). Baptist et al. (2021) found increased theta activity in the dPFC and ACC. van der Kolk (2015) concludes that these changes in brain regions associated with regulation and integration suggest EMDR helps integrate trauma memories, regulate emotions, and restore a sense of agency.

7. Stein et al. (2004) suggested EMDR induces a therapeutic altered state of consciousness (ASC). Grant (2023) agrees that EMDR’s use of relaxation, somatic focus, and focused attention induces an ASC. My original hypothesis is that an ASC may result from brainwave entrainment, a phenomenon in which brainwave activity synchronises with the BPM of a rhythmic stimulus (Sadek et al., 2023).

Most trauma specialists consider EMDR a gold standard trauma intervention (Beauveas et al., 2023). EMDR is internationally recognised as an effective, evidence-based PTSD treatment (World Health Organisation, 2018). It has been recommended by Phoenix Australia since 2013. However, the Australian Psychological Society (APS) did not endorse EMDR for PTSD until 2018.

EMDR’s effects are more immediate and faster than those of trauma-focused CBT (Shapiro, 2014). Numerous studies and meta-analyses provide strong evidence that EMDR can resolve simple, single-incident traumas in 3 to 6 sessions. Unlike CBT, EMDR is also effective for both Complex and Dissociative PTSD types (De Jongh & Hafkemeijer, 2024; Winkler et al., 2023). Trauma experts often modify EMDR to treat more complex presentations. For example, some therapists combine EMDR with hypnosis (Grant, 2023; Harford, 2010).

The APS published an article capturing Australia’s systemic bias against EMDR (Struik, 2019). The author asserts that many Australian psychologists and counsellors, who are focused on symptom management instead of addressing the underlying trauma aetiology, remain ignorant of EMDR. 

Struik (2019) notes that some Australian institutions actively discourage EMDR. As a University of Queensland graduate, I know their psychology and psychotherapy faculties are fiercely anti-EMDR and pro-CBT to the point where they forced a PhD in candidate to change her independent variable from EMDR to CBT at the threat of being expelled from their program. This is the same university where Peter Sheehan, who was trained in MK-Ultra techniques by head CIA psychologist Martin Orne in 1960, ran an MK-Ultra hypnosis lab from the 70s to 90s where it was mandatory for all students taking introductory psychology to participate in group hypnosis studies.

Unlike CBT, EMDR is an external training program that the graduate clinician must self-fund.

Conclusion

CBT earned global acceptance through fabrication. Its mechanism of action renders it completely ineffective for treating trauma and dissociation. Despite this, institutions responsible for training therapists continue the perpetrator legacy by promoting and spreading CBT and simultaneously suppressing EMDR.

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