If you’re living with obsessive-compulsive disorder (OCD), it’s likely you want to explore all of your treatment options. While research shows that exposure response and prevention (ERP) therapy is the most effective way to manage OCD symptoms, you may be curious about alternative treatments.
One type of therapy that has gotten more attention in recent years is eye movement desensitization and reprocessing (EMDR) therapy. It works by utilizing an eight-step protocol to move your eyes in a specific manner under the guidance of a trained therapist. This is done in an effort to process lingering trauma and/or distress. Read on to gain a better understanding of EMDR therapy, and whether it can help your OCD.
In This Article
What is EMDR therapy?
EMDR is a relatively new treatment originally developed in the 1980s for post-traumatic stress disorder (PTSD). An EMDR-trained therapist guides you in back-and-forth eye movements, while helping you recall painful memories. Unlike many other forms of therapy, you don’t have to actually talk about the moments of distress you’re trying to process. Instead, you just allow yourself to acknowledge any feelings or thoughts that arise during the session.
While researchers don’t exactly know how EMDR works, the hypothesis is that these eye movements take up enough mental energy to preoccupy the brain, which in turn lessens your emotional responses to triggers, and allows you to “reprocess” painful events or situations that feel too large to heal from on your own. The idea is that processing these troubling memories can help you acknowledge emotional pain you may be suppressing, while gaining new insights that can help you heal.
“There’s a belief that thinking of the trauma while experiencing what they call a bilateral stimulation—like the eyes moving back and forth—somehow helps the brain to process the trauma better,” explains Dr. Patrick McGrath, PhD, chief clinical officer of NOCD. The therapy is named after eye movement exercises, but some therapists use other bilateral methods, too—like tapping devices in each hand, or using headphones to play alternate tones in each ear. These options can be helpful for people who struggle with rapid eye movements due to seizures, migraines, or other related conditions.
NOCD chief compliance officer Tracie Ibrahim says that in recent years, researchers and therapists have been experimenting with EMDR therapy to treat anxiety and OCD. But, she cautions that these approaches aren’t always evidence-based: “Unfortunately there is a ton of false information about what OCD is and how to treat it.”
How EMDR works
Note: There is no standard protocol for incorporating EMDR as treatment for OCD. The below protocol references EMDR recommendations for PTSD.
- Phase 1 – History-taking: A mental health professional gets your full history and conducts assessments. Then, you work together to identify what you’ll be targeting in sessions, which is often a traumatic memory.
- Phase 2 – Prep: This stage is all about education. Your therapist will lay out how EMDR works, and teach you strategies to deal with any distress that arises during treatment—such as breathing techniques or meditation. During this phase, your therapist will also teach you how to signal that you want to stop EMDR, if it becomes too much to handle at any given point.
- Phase 3 – Activating target memory: Your therapist will ask questions to activate your trauma memory and bring it to the front of your mind. This could take as little as thirty seconds.
- Phase 4 – Desensitization: You begin eye movement/bilateral stimulation. You are asked to focus on a traumatic memory while you do eye movements, like following a dot left to right. The goal here is to keep moving your eye and focusing on the memory until it no longer feels distressing.
- Phase 5 – Installation: Right after desensitization, your therapist will have you begin eye movements again, this time while focusing on new, positive beliefs related to the traumatic memory. This might mean thinking, “I am safe. They can no longer hurt me.”
- Phase 6 – Body scan: You do a body scan to assess if there are any negative sensations arising. If so, you will continue on with bilateral stimulation until those feelings disappear.
- Phase 7: Closure: Your therapist brings you back to the present moment.
- Phase 8: Evaluating treatment: You will go over with your therapist how you feel after the entire treatment, and discuss if the memory still feels overwhelming.
Side effects of EMDR include:
- big releases of emotion, like crying
- physical sensations
- fatigue
- lightheadness
- vivid dreams or nightmares
- temporary increased emotional reactivity, anxiety, or fearfulness
- heightened sensitivity to external stimuli, such as noise
- Increased recall of memories emerging outside of sessions
Does EMDR work for OCD?
Far more research has been done on EMDR for PTSD than on EMDR’s efficacy for OCD. The studies that have considered EMDR for OCD are mostly small—though some found the therapy could be helpful. Many OCD experts, however, including Dr. McGrath and Ibrahim, don’t view the therapy as a good treatment for OCD. “There isn’t longitudinal, peer-reviewed, meta-analyzed data that supports EMDR as being effective for OCD,” says Ibrahim.
Can EMDR make OCD worse?
Since EMDR hasn’t been well-studied, experts are not totally sure of its impact on those with OCD. What we know from the research is that no studies have shown EMDR to worsen OCD in the long-term. That being said, it’s important to be mindful that in the short-term, the act of intentionally bringing traumatic feelings to the surface may cause increased distress—and high levels of distress can temporarily cause your OCD symptoms to flare, if you’re not equipped with response prevention tactics.
Plus, if you have OCD, some EMDR bilateral simulation techniques may feel compulsive. “Some people with OCD have physical compulsions that are repetitive, like tapping,” Ibrahim explains. Relying on deep breathing as a way to respond to intrusive thoughts can also be problematic for people with OCD, she says: “Deep breathing interferes with our brain’s ability to naturally habituate to obsessional fears, which gets in the way of getting OCD symptoms to be more manageable.”
What’s the most effective treatment for OCD?
The best way to treat your OCD is to reach out to a therapist trained in exposure and response prevention (ERP) therapy—a specialized form of cognitive behavioral therapy (CBT) designed to help reduce OCD symptoms.
In ERP, you’ll work with a therapist to gradually expose yourself to situations that trigger your obsessions, and make you want to perform compulsions. Instead of engaging in these compulsions, you’ll learn to practice response prevention techniques.
For example, if difficult intrusive thoughts make you feel the urge to tap your desk hundreds of times a day, your ERP therapist might start off by helping you bring this number down to 50 times a day. From there, you might reduce your tapping amount each day. By shortening these behaviors, your brain learns that compulsions aren’t necessary to survive the feelings of anxiety that drive them.
What if I have PTSD and OCD?
If you have both PTSD and OCD, Dr. McGrath advises using prolonged exposure (PE), which is another ERP-based treatment designed specifically for PTSD. “There’s good backing for that treatment,” Dr. McGrath explains. ERP and PE work well together because their similarities make it easier to engage in both modalities.
PE works by teaching you to gradually and intentionally approach your trauma-related experiences and feelings. The goal is to learn these skills in situations that do not pose any real danger. For example, your therapist might encourage you to imagine your traumatic memory, during a therapy session, and pay close attention to which emotions arise. By learning to identify negative thoughts that emerge, and confront these painful memories in a controlled environment, you’ll be able to better cope with related feelings that arise outside of sessions.
Like with ERP therapy for OCD, PE can be difficult because it involves confronting painful situations head-on. But, avoiding difficult memories can reinforce fears—making it harder to encounter similar or related situations, events, and people.
While ERP and PE can be done with the same therapist during the same period of time, in alternating sessions, in some cases Dr. McGrath says it can be helpful to engage in PE first, before diving into ERP.
“We’ve noticed that sometimes PTSD can interfere with OCD treatment, because of all the nightmares, flashbacks, and avoidance behavior,” he says.
We’ve noticed that sometimes PTSD can interfere with OCD treatment, because of all the nightmares, flashbacks, and avoidance behavior,”
Dr. Patrick McGrath
“So, in many cases, we’ll typically address the trauma first, then we’ll go back to ERP afterward,” he adds.
Unlike EMDR, both PE and ERP focus on habituating you to feelings of distress, rather than offering the potential to engage in potentially compulsive, repetitive behaviors like bilateral movements or deep breathing.
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Bottom line
Much more research is needed on the efficacy of EMDR therapy for OCD. For now, keep in mind that some EMDR techniques may feel compulsive, and that other evidence-treatments like PE and ERP exist. If you’re dealing with both OCD and PTSD, a combination of PE and ERP can help you get your life back on track.