EMDR for OCD

Obsessive-Compulsive Disorder (OCD) is a mental health condition that can seriously interfere with daily life. It involves intrusive, distressing thoughts (obsessions) paired with repetitive behaviors or mental acts (compulsions) intended to reduce anxiety or prevent a feared outcome. While Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), is the standard treatment for OCD and works well for many, Eye Movement Desensitization and Reprocessing (EMDR) has recently gained attention as a potential treatment for OCD. Although EMDR is more commonly used for PTSD, it has shown promise in helping people manage OCD symptoms, and can even be combined with CBT for a more comprehensive approach.

In this article, we’ll dive into what EMDR is, how it’s used to treat OCD, who might benefit from it, and how it compares to traditional treatments like CBT. We’ll also explore the pros and cons of EMDR for OCD and provide examples of both physical and mental compulsions to better illustrate how OCD impacts daily life.

What is EMDR?

EMDR (Eye Movement Desensitization and Reprocessing) is a therapeutic technique developed by Francine Shapiro in the late 1980s to help people process traumatic memories, particularly those that cause PTSD, and reduce the emotional distress associated with them. Shapiro discovered that certain eye movements could alleviate the emotional charge of distressing memories, leading to the development of EMDR as we know it today. The therapy follows a structured eight-phase approach that helps clients revisit upsetting memories in a way that makes them more manageable.

The core idea behind EMDR is that when traumatic or intrusive memories are processed in a controlled, safe environment, their emotional intensity can be significantly reduced. Over time, this makes it easier for individuals to face these memories without being overwhelmed by anxiety or fear. Rather than just talking through the problem, EMDR actively helps the brain "reprocess" memories, allowing them to lose their emotional charge.

Although EMDR was originally designed for PTSD, it has also been explored as a treatment for OCD and other psychological disorders. Many individuals with OCD struggle with intrusive thoughts that trigger high levels of anxiety. EMDR helps by reprocessing these thoughts, reducing their emotional intensity and making them less overwhelming. Instead of responding with compulsions to alleviate anxiety, individuals can begin to face their obsessions with greater calm over time.

How EMDR works

There are several theories on why EMDR is effective, and most of them center around its ability to help the brain process and reframe traumatic or distressing experiences. Here’s a look at some of the key neurological reasons that help explain why EMDR works:

Bilateral Stimulation and Brain Activity

Bilateral stimulation—using things like alternating eye movements, sounds, or taps—works by engaging both sides of your brain. It's thought to mimic what happens during REM sleep, when the brain works to process and organize memories. During REM, your brain sorts through your experiences, helping to turn them into a more manageable, less emotionally intense memory. In EMDR, this same kind of stimulation is believed to help your brain process traumatic memories in a similar way, reducing their emotional charge and making them easier to handle, just like your brain would “file away” those experiences while you’re sleeping.

Memory Reconsolidation

Memory reconsolidation is when a memory becomes flexible and can be updated or re-written when you recall it. When someone thinks about a traumatic memory, EMDR helps the brain "rewrite" the emotional weight of that memory. The bilateral stimulation in EMDR creates the right kind of environment in the brain for these memories to be reprocessed, so they lose some of their emotional intensity. This is really helpful for people with PTSD or OCD, where upsetting memories or thoughts can trigger huge emotional reactions.

Reducing Overactive Amygdala Activity 

The amygdala is the part of the brain that handles emotions, especially fear and anxiety. For people with PTSD, OCD, or other anxiety-related disorders, the amygdala can get overactive, making emotional reactions to memories or thoughts more intense. EMDR’s bilateral stimulation is thought to help calm down the amygdala. By using this technique, EMDR helps regulate the emotional center of the brain, making it easier for people to process memories and thoughts without getting totally overwhelmed by fear or anxiety.

Activation of the Prefrontal Cortex

The prefrontal cortex (PFC) is the part of the brain that helps with things like decision-making, controlling emotions, and managing responses to stress. For people with OCD or trauma-related disorders, the PFC might not be as active when they’re dealing with upsetting thoughts, which makes it harder to control emotional reactions. EMDR helps activate the PFC, boosting its ability to manage emotions and thoughts. This makes it easier to challenge irrational or distressing thoughts—like the obsessive fears in OCD—and reduce the urge to act on them with compulsive behaviors.

Integration of the Left and Right Brain Hemispheres 

The left and right sides of the brain handle different types of information. The left side focuses more on logic and analysis, while the right side deals with emotions and intuition. EMDR is thought to help connect these two sides, improving how the brain processes and regulates emotions. This connection can help people with OCD or trauma-related disorders look at their intrusive thoughts in a more balanced way, making it easier to reduce the emotional impact and break the cycle of compulsive behaviors.

Decreasing Hyperarousal 

Hyperarousal is when someone feels constantly on edge, anxious, or overly alert—something that often happens with PTSD, OCD, or other anxiety disorders. It’s linked to an overactive stress response system. EMDR helps calm this down by reprocessing upsetting memories and lessening the emotional weight they carry. As the emotional intensity drops, people can handle those memories or thoughts with more tolerance, which can reduce the urge to engage in compulsive behaviors or avoid certain situations.

What to Expect from EMDR Sessions for OCD

In an EMDR (Eye Movement Desensitization and Reprocessing) session for OCD, the process focuses on addressing and reducing the anxiety tied to obsessive thoughts. The goal is to break the cycle of obsessive thinking and compulsive behaviors that often leave you feeling stuck. Let’s take a look at how an EMDR session might unfold using a specific example of contamination OCD.

At the start of the session, your therapist will help you pinpoint the specific thought or behavior you want to focus on. For example, if you struggle with contamination OCD, you might experience a fear of germs, prompting you to wash your hands repeatedly. The therapist will guide you in recalling a specific moment where this fear was triggered, such as a time you touched a public door handle and felt an overwhelming urge to wash your hands afterward.

Once you’ve identified the issue, the therapist will help you focus on it. They may ask you to rate how distressing the thought or memory is on a scale from 0 to 10. For instance, if thinking about the door handle triggers intense anxiety, you might rate the distress as a 9 or 10. This helps the therapist understand the intensity of the distress and track your progress throughout the session.

The core part of EMDR is bilateral stimulation, which involves engaging both sides of the brain to process emotional reactions. Your therapist may ask you to follow their finger back and forth with your eyes, listen to alternating tones in headphones, or tap your hands. While doing this, you’ll continue focusing on the intrusive thought, such as the idea that you’ve touched something contaminated. This stimulation helps your brain process the emotional charge tied to that thought.

As you continue with the bilateral stimulation, your brain starts to process the obsession, and the emotional intensity of the thought gradually decreases. For example, the overwhelming fear of contamination from touching the door handle may begin to fade. The therapist may also guide you to notice any physical sensations you experience as the anxiety rises, encouraging you to let those feelings fade while continuing the stimulation. Over time, the distress tied to the obsessive thought lessens, making it easier to manage.

Once the distress has been reduced, the therapist will help you reframe the thought. Instead of believing that touching the door handle makes you contaminated, the therapist might guide you to acknowledge that germs are a normal part of daily life and that washing your hands once is enough. This shift in perspective replaces the irrational fear with a more balanced view, reducing the need for compulsive behaviors like excessive hand-washing.

At the end of the session, the therapist will ask you to re-rate the distress level of the thought. If the distress has decreased (for example, from a 9 to a 4 or 5), that indicates the processing is effective. Over multiple sessions, you’ll continue working through different obsessive thoughts, gradually reducing the anxiety and compulsive behaviors associated with them.

In short, EMDR helps you focus on a specific obsessive thought while engaging in bilateral stimulation to process and reduce its emotional impact. Over time, this method enables you to manage OCD symptoms, break the cycle of compulsive behavior, and find lasting relief.

EMDR as a Stand-Alone Treatment vs. Pairing with CBT

When it comes to treating OCD, EMDR is typically not used as a stand-alone treatment. Instead, it is often paired with Cognitive Behavioral Therapy (CBT), particularly the Exposure and Response Prevention (ERP) component, which is considered the gold standard for treating OCD.

CBT, specifically ERP, involves exposing the person to their obsessive thoughts or feared situations while preventing the usual compulsive response. This helps individuals gradually confront their fears and learn that their anxiety will naturally decrease over time without the need for compulsions. ERP helps individuals change their behavioral patterns by breaking the cycle of obsession and compulsion.

EMDR can complement CBT by addressing the emotional and traumatic aspects of OCD that may not be fully processed in traditional therapy. While CBT focuses on changing behaviors and thoughts, EMDR targets the emotional intensity behind these thoughts and can help individuals process past experiences or underlying trauma that may contribute to the development or persistence of OCD.

Some individuals may benefit from using EMDR as a supplemental treatment to CBT, especially if their OCD is rooted in trauma or distressing past experiences. For example, if an individual has experienced trauma that exacerbates their OCD symptoms, EMDR could help process the trauma and reduce its emotional impact, making it easier for them to engage in ERP.

Who is a Good Candidate for EMDR for OCD?

Not everyone with OCD will be a good candidate for EMDR. However, individuals who have tried traditional treatments like CBT with limited success, or those whose OCD is particularly distressing and tied to past traumatic experiences, may benefit from EMDR. EMDR may be particularly helpful for individuals who have a history of trauma or emotional pain that exacerbates their OCD symptoms, as it can address both the obsessive thoughts and the emotional distress that accompanies them.

Additionally, individuals who are open to exploring alternative therapeutic approaches or those who find traditional CBT techniques difficult to engage with may find EMDR to be a helpful addition to their treatment plan.

Pros and Cons of EMDR for OCD

Pros:

• Effective for trauma-related OCD: EMDR can be particularly helpful for individuals whose OCD is connected to past trauma or distressing experiences.
• Complementary to CBT: When used alongside CBT, EMDR can help address emotional distress and make it easier for individuals to engage in ERP.
• Quick results: Some individuals may experience quicker relief from distressing thoughts compared to traditional therapy.

Cons:

• Not a one-size-fits-all approach: EMDR may not be as effective for all individuals with OCD, particularly those without a trauma history.
• Requires trained therapists: EMDR should only be administered by a trained and certified therapist, which may limit access to treatment.
• Can be emotionally intense: For some, the process of reprocessing traumatic memories can be emotionally taxing.

Contraindications:

• Severe dissociation: Individuals who experience severe dissociation or have a history of severe trauma may require specialized care before engaging in EMDR.
• Unstable mental health: Those with severe depression or other serious mental health issues may need additional treatment before starting EMDR.

Conclusion

EMDR is an exciting and evolving approach in the treatment of OCD. While not yet as widely used as traditional treatments like CBT and ERP, EMDR offers promising results, especially when combined with these therapies. It can be particularly beneficial for individuals whose OCD symptoms are intertwined with trauma or intense emotional distress. Like all treatments, EMDR is not suitable for everyone, but for the right candidate, it can be a powerful tool in managing and reducing the impact of OCD. By addressing both the cognitive and emotional aspects of the disorder, EMDR may offer a well-rounded and effective addition to the treatment toolbox for OCD.

References

1. van den Hout, M. A., & Engelhard, I. M. (2013). Eye movement desensitization and reprocessing (EMDR) as a treatment for posttraumatic stress disorder: A meta-analysis. Journal of Anxiety Disorders, 27(6), 558-564. https://doi.org/10.1016/j.janxdis.2013.07.006
2. González, S. M., & Frey, L. M. (2017). EMDR therapy for obsessive-compulsive disorder: A case report. Psychological Trauma: Theory, Research, Practice, and Policy, 9(5), 588-590. https://doi.org/10.1037/tra0000240
3. Hase, M., Schallmayer, S., & Pohlmann, B. (2019). EMDR as a treatment for obsessive-compulsive disorder: A case study. Journal of EMDR Practice and Research, 13(3), 155-163. https://doi.org/10.1891/1933-3196.13.3.155
4. Shapiro, F. (2014). EMDR therapy: An overview of the approach. https://emdria.site-ym.com/resource/resmgr/docs/EMDRIA_EMDR_Overview.pdf
5. Brown, C., & Shapiro, F. (2018). EMDR and OCD: A promising treatment for obsessive-compulsive disorder. Journal of Clinical Psychology, 74(3), 482-493. https://doi.org/10.1002/jclp.22530