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This article is evidence-based, verified by Dr. Ahmed Zayed.
Obsessive-compulsive disorder, or OCD, is a commonly misunderstood disorder. People who struggle with OCD symptoms struggle in many ways, and symptoms don’t always match the obsessive cleaning, hand washing, and counting portrayed in popular media.
Many people who have OCD also have a history of trauma, and psychology research is just beginning to understand the link between the two.
Eye movement desensitization and reprocessing (EMDR) therapy has been shown to reduce OCD symptoms and be especially effective for OCD when paired with trauma processing therapy. Studies show that many patients begin to experience OCD symptom relief after 2-3 EMDR treatment sessions.
Here, we’ll take a look at how the brain functions when affected by OCD, how trauma and OCD are often connected, and how EMDR therapy can lead to the relief of OCD symptoms, both for people who have been affected by trauma and people who have not been affected by trauma.
What is OCD?
As the name of the disorder states, OCD is made up of two facets: obsessions and compulsions. Obsessions are repetitive, unwanted thoughts that often cause great distress to the person having the thoughts. Compulsions are unwanted behaviors that the brain reasons will help to stop the obsessive thoughts.
Obsessions can include worrying about others’ safety, fears of contamination, worries of abandonment, and other types of devastating life stress.
It can feel nearly impossible for people who deal with OCD to refuse to engage in a compulsion, much like it can feel impossible not to scratch an itch or to sneeze after looking at the sun.
People who have OCD may feel desperate to do whatever it takes to stop unwanted thoughts, even though they know logically that engaging in compulsions won’t do anything to change what’s happening int he world around them.
OCD is classified as an anxiety disorder, but people who suffer from OCD are first to explain that the condition causes far more distress than feeling worried or anxious from time to time.
Recent research has shown that pathways in the brain work differently in people who have OCD. Their perception of error and their inhibitory systems can work together to rectify a mistake for most people. For people with OCD, this process becomes more complicated.
According to the University of Michigan psychiatry faculty member Kate Fitzgerald, “It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them.”
OCD and Underlying Issues
The prevalence of OCD is much higher in people diagnosed with PTSD than in the general population. While not everyone who experiences trauma develops PTSD, many people who experience trauma develop at least some PTSD symptoms.
Scientists believe that OCD symptoms develop as a way to help the brain cope with PTSD, providing a sense of control and relief from a traumatic situation that the brain is struggling to process.
EMDR is commonly used as a treatment for trauma, and today’s research shows that the treatment is effective for people who are suffering from OCD symptoms.
Let’s look at how EMDR therapy works to rewire how the brain processes difficult and stressful events.
How Does EMDR Work?
EMDR was originally developed to help trauma patients rewire the pathways responsible for processing their trauma. There are several goals of EMDR that can work for both trauma issues and OCD:
- Relieve affective stress
- Reduce stress response/ hyperarousal
- Reformulate negative beliefs
EMDR provides patients with a safe, constructive environment to revisit trauma, working to change the memory systems used for trauma.
EMDR can help patients develop new automatic mechanisms for coping with stressors by combining painful memories with external stimulation.
For people who have OCD, EMDR can be especially effective. One of the key struggles of people who have obsessive thoughts is the automatic factor – no matter how much they try to stop the thoughts (and the compulsions that become associated with the thoughts), it can feel impossible.
EMDR can help patients develop new thought processes that can help change the automatic nature of obsessive thoughts, therefore easing compulsions.
Patients with OCD may develop obsessive thoughts and compulsive behaviors due to the brain’s inability to process difficult thoughts and memories fully.
This doesn’t mean something is wrong with the brain. Rather, it means that the brain works to protect the person by keeping painful memories as distant as possible.
EMDR allows patients to work through pain and trauma in a healthy way, which can have a cascade of positive effects on their well-being.
What Happens During an EMDR Therapy Session?
The process of EMDR therapy varies between practitioners, but usually, EMDR therapy includes the following:
- The practitioner will first establish a trusting, positive rapport with the patient, including talking with them about their goals for EMDR therapy. This may take several sessions.
- After history-taking is complete, the therapist will work with the patient to discuss their coping mechanisms for stress. This is an important part of ensuring that the patient has the mental fortitude to undergo EMDR therapy safely.
- The practitioner works to help the patient access painful or traumatic memories for brief periods of time, while also focusing on an external stimulus. While the exact method may vary, some practitioners direct patients to tap handheld buttons, others direct eye movements, hand tapping, and auditory stimulation to help the patient keep an external focus. During this process, patients are asked to recall a painful or traumatic memory, a negative belief that they hold about themselves, and how their body reacts when they think about the traumatic situation and their negative beliefs.
- Following the processing sessions, clients are asked to keep a log for the week, noting how their minds and bodies react when material related to the trauma occurs in daily life. This log gives the practitioner insight into how well the therapy is working, and whether it’s a good idea to continue moving forward with EMDR.
- Throughout this therapy, past events are processed healthily, allowing patients to lay new groundwork for remembering painful or traumatic events.
- Over time, EMDR can work to decrease sensitivity to both internal and external triggers. The practitioner regularly checks in with the patient to ensure positive progress is being made.
- Practitioners work with patients to develop a framework for potential future stressful events, allowing them to learn new ways to process immediately.
How effective is EMDR for OCD?
EMDR is a hopeful treatment for people who suffer from OCD. Studies show that EMDR therapy for OCD is most effective for people who have OCD related to trauma.
This does not necessarily mean that the patients who are most likely to benefit from EMDR for OCD also have PTSD (although that is possible).
Many patients who have trauma-related OCD have some PTSD symptoms but do not have enough symptoms to be diagnosed with PTSD.
In patients who have been diagnosed with OCD, slightly over 30% of participants show a significant decrease in OCD symptoms. While this is not as high as some other OCD treatment methods, many patients find that they’re more able to complete EMDR sessions than other therapy types.
For example, exposure therapy can be too stressful for patients to complete – up to 25% of patients who begin exposure therapy refuse to complete treatment, as they find it too stressful to be beneficial.
Research is ongoing, and EMDR practitioners are hopeful that ongoing EMDR treatment for people with OCD can prove to be a useful treatment method.
For patients interested in trying EMDR therapy, it often makes sense to begin the EMDR process while continuing with other therapy types.
How long do the effects of treatment last?
Recent randomized studies have shown that EMDR treatment effects for OCD are well-maintained at six months after the final EMDR session.
One of the tenets of EMDR therapy is working on learning how to process future events, and this aspect of treatment may be one of the key reasons patients find EMDR therapy effective in the long-term.
Some patients have even shown that they have a greater reduction of symptoms six months after the end of treatment than they did at their final EMDR session, leading researchers to hypothesize that EMDR’s effects continue to work in the brain long after the formal therapy has concluded.
If you’re working through an OCD treatment with your therapist and feel that it’s no longer as effective as it was for you initially, it’s important to bring this up at your next session.
Your therapist can work with you to help you find the modality of therapy (or combination of modalities) that makes the most sense for you).
As your life situation changes, and you learn new ways to respond to stressors, it makes sense that your therapy needs may change.
EMDR for OCD: Can several modalities of treatment work together?
EMDR and other treatments, such as cognitive-behavioral therapy (CBT), can work together to ease a patient’s symptoms, but it’s important to note that EMDR is its own treatment.
An EMDR therapy session does not combine with a CBT therapy (or any other type of therapy) session.
Studies on the combination of EMDR and CBT therapy are generally anecdotal at this point. Still, they suggest that the combination of both types of therapy can be effective for patients struggling to see results from one type of therapy on its own.
Some patients may find CBT to be more stressful than EMDR therapy, as CBT requires patients to confront past events directly, challenges their current belief systems outright, and can require patients to focus on traumatic events for long periods of time.
EMDR only requires patients to think about their trauma in short bursts, while also actively working to change how the brain processes the event. This difference in approach can make a difference in the patient’s ability to withstand therapy’s emotional difficulties.
Comparing Treatments: EMDR vs. Other Common Treatments
|EMDR||30% of patients studied while undergoing EMDR therapy for OCD had a statistically significant reduction in symptoms.|
|Talk therapy (specifically, CBT)||Studies show that CBT can be effective in reducing symptoms for up to 80% of patients. However, nearly a quarter of patients find CBT/ exposure therapy too stressful to complete treatment.|
|Medication||About half of patients prescribed antidepressants for OCD experience a reduction in symptoms (typically between 40-60% reduction).|
|Exercise||When used in conjunction with other OCD treatments, exercise has been shown to reduce OCD symptoms over time.|
Dr. Ahmed Zayed, MD, holds a baccalaureate of Medicine and Surgery. An avid contributor to the Huffington Post and Chicago Tribune, Dr. Zayed believes in providing accurate and accessible information to general readers. With years of writing and editing content in the medical niche, Dr. Zayed likes to think of himself as a man with a mission, keeping the internet free of false medical information.