EMDR for OCD: How It Works, Examples, & Effectiveness

What Is EMDR?

Eye movement desensitization and reprocessing therapy (EMDR) is a therapy centered around treating trauma, where a person focuses on a memory or emotion, while at the same time doing some form of bilateral stimulation, usually eye movements. EMDR uses adaptive information processing (AIP), which posits that people have a natural information processing system wired for growth and healing.¹

EMDR aims to reduce negative emotions, feelings, and sensations associated with memories or previous experiences. When someone’s memory networks begin to store these more adaptively, they will become less reactive to those memories, leading to fewer symptoms in their daily life. Part of the EMDR process also involves learning new coping skills and relaxation exercises to help people better manage symptoms that linger.¹

What Is OCD?

Obsessive compulsive disorder (OCD) consists of persistent, unwanted, and distressing thoughts or behaviors which often take up significant time and energy, causing considerable anxiety and interfering with daily functioning. People with OCD may engage in repetitive actions or mental rituals to try to alleviate their distress or prevent feared outcomes.

OCD affects 1-2% of the population, and females are more often diagnosed than males in adulthood.³ While OCD is closely related to anxiety, it is categorized separately.³ OCD is highly genetic, with 2-10x increased risk if a first-degree relative has also been diagnosed with it. Rarely, OCD symptoms can be caused after a traumatic event or as an autoimmune response to an infection.³

OCD is characterized by obsessions and compulsions:

• Obsessions: Obsessions refer to persistent and intrusive thoughts, urges, or images that cause significant distress and anxiety. These obsessions are unwanted and difficult to control.
• Compulsions: Compulsions are behaviors or mental rituals aimed at reducing distress or preventing feared outcomes of the obsessions.

Does EMDR for OCD Work?

All the current evidence indicates that EMDR is helpful in treating OCD. One randomized controlled trial found a significant reduction in OCD symptoms. Another, which compared EMDR for exposure and response prevention (ERP) for treating OCD, found that EMDR can help with OCD, at least as well as ERP or commonly prescribed OCD medications.⁴

One element of EMDR that is particularly relevant to how EMDR works for OCD is exposure. Part of the reason exposure-based therapies like ERP work so well for treating OCD is due to inhibitory learning, wherein a person learns that both triggers and the emotional response they fear are safe and can be tolerated. EMDR can be an alternative means to accomplish inhibitory learning, as it safely exposes a person to their triggers.²

Why Is EMDR Effective for OCD?

A main feature of EMDR treatment is integrating distressing memories so that they are more emotionally tolerable. EMDR may make it easier for people with OCD to withstand the uneasy feelings generated by either refraining from doing a compulsion or of feeling out of control with their obsessive thoughts.

One explanation for the development of OCD is that distressing life events get stuck, much like trauma, and present as obsessions. Thus, the obsession or the following compulsion is likely associated with a negative neural network, which has feelings and thoughts connected to it.⁴ EMDR can target the most distressing aspects of OCD – triggers, past trauma, or possible future situations that may prompt obsessions or compulsions.

EMDR Protocol for OCD Treatment

There are a variety of protocol adaptations a therapist may choose from when doing EMDR for OCD. They may begin a client’s treatment with EMDR to reduce emotional distress, or they may choose to do a course of ERP before beginning EMDR. The protocol adaptations a therapist chooses will also depend on their client’s particular symptoms.⁵

The protocols used will either target the obsession itself or a traumatic event that is connected to a person’s OCD symptoms. The only clinical trial that has published its methodology at this point used the EMDR Phobia Protocol, wherein current triggers (obsessions and compulsions) were the first targets.⁴

EMDR for Disorders That Co-Occur With OCD

While using EMDR to treat trauma has been the most studied, research so far suggests that EMDR can also be useful in treating a variety of disorders. EMDR primarily targets the emotions and memories underlying disorders, which can be applied to anxiety or depression, which are often comorbid with OCD.^1,3

There have been no studies specifically looking at EMDR for generalized anxiety disorder, but studies carried out on specific phobias and panic disorder show positive outcomes when incorporating EMDR into treatment.⁷ EMDR may be used as an adjunct to standard treatments, such as cognitive behavioral therapy (CBT), but it is also effective for treating co-occurring disorders when used alone.⁶

Other Treatment Options for OCD

OCD treatment most often begins with ERP and is sometimes combined with a medication regimen. Treating OCD involves a comprehensive assessment such as a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to determine which OCD symptoms are present and how much they impact a person’s daily life in order to choose and begin the best treatment for their unique case.

Other treatment options for OCD include:

• Exposure response therapy (ERP): Exposure and response prevention for OCD is the gold standard treatment and involves intentionally exposing a person to their obsessions while inhibiting their compulsive response. Exposures may be imaginal, real life, or interoceptive, meaning focused on their internal sensations.
• Cognitive behavioral therapy (CBT): CBT for OCD uses a variety of therapeutic techniques to focus on interrupting the thought, feeling, and behavior patterns that are characteristic of OCD.
• Acceptance and Commitment Therapy (ACT): ACT emphasizes connecting to and experiencing fully the present moment regardless of how uncomfortable it is. ACT posits that if a person can accept and welcome the intolerable-seeming feelings, the need to do compulsions will decrease.
• Habit Reversal Training (HRT): HRT introduces a competing response for a compulsion, thus replacing a dysfunctional behavior with a more helpful one.
• Medications: Medications for OCD, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, are often employed when therapy alone has not been very helpful or if symptoms are too severe to experience benefit from therapy without pharmacotherapy.

How to Find an EMDR Therapist for OCD

Many therapists are trained in treating OCD, and many are trained in EMDR, but treating OCD with EMDR is less common. EMDR therapy is available online and can be as effectively delivered as in-person, so individuals seeking EMDR therapy for OCD are not as limited to their local area.⁸ A great place to search for an EMDR therapist is an online therapist directory or online therapy platform built to help find the right therapist for every individual.