EMDR and OCD
I wanted to start this blog series because I’m a therapist who was trained in EMDR about 2 years ago (2023). Despite having 2 years of experience with EMDR, I’m still finding myself being shocked and excited about all the different ways EMDR processing can be utilized to treat various conditions. I’m excited to write this blog series because I’m hoping this can help people find treatment options for their specific concerns that they may not have realized was an option for them. So, buckle up and get ready to learn more about how EMDR can be used to treat OCD!
What is OCD?
OCD, or obsessive-compulsive disorder, is a disorder in which people have recurring, intrusive, unwanted thoughts, ideas, or sensations called obsessions. These obsessions elicit negative emotions within the person, which drives them to want to relieve the emotions. This relief usually comes in the form of a repetitive act (this act can be internal or external) called compulsions. Some common repetitive behaviors can be things such as hand washing, checking to make sure the stove is off, repeating certain numbers or phrases in your mind, asking repetitive questions, etc. For someone to be diagnosed with OCD, they must experience these obsessions and compulsions for more than an hour a day and they must cause significant distress and impair functioning at home, work, and/or school. Most people find that, even if they try, they cannot suppress or ignore the disturbing thoughts, urges, or images.
What is EMDR?
For background, EMDR has a basic protocol which can be used to treat ‘big T’ and ‘little t’ traumas and is the blueprint and foundation for which most processing sessions will follow. It’s structured, highly effective, and evidenced-based, shown by numerous studies to reduce symptoms of trauma, anxiety, depression, substance use, and more. In treating this wide variety of mental health symptoms and diagnoses, there are a few ‘tweaks’ to the basic protocol that can be made to be more effective for the specific concern being addressed. Even with these tweaks, usually most (if not all) elements of the basic protocol are interwoven into these other protocols, just in different ways.
EMDR and OCD
For OCD, some of the tweaks made to the basic protocol are made to help the client establish new adaptive neural networks to create distance from their OCD obsessions and compulsions. This protocol for OCD is aptly named the Distancing Technique. The Distancing Technique has 3 components- distancing, future rehearsal, and standard EMDR protocol. The additions of distancing and future rehearsal were introduced to the standard protocol as the ‘tweak’ to help with OCD because OCD tends to lead clients to experience:
- An over importance of thoughts
- A need to control thoughts
- Misinterpretation of sensations and/or of predictors of future catastrophe
While other mental health diagnoses may include elements of these 3 difficulties, clients with OCD experience these at such a rate that makes doing standard protocol for EMDR difficult as they can act as roadblocks in processing. The goal of the distancing technique is to help the client become a detached observer and develop adaptive coping statements. Then, these adaptive coping statements, once reinforced in processing, can be interwoven for future rehearsal. Once OCD symptoms decrease or diminish entirely, standard EMDR protocol can be introduced to address other concerns or traumas that may have influenced OCD to develop in the first place.
What can I expect if my EMDR therapist wants to use the Distancing Technique?
Great question! If you are engaging in EMDR for the first time, or if you’ve been doing processing for a while and you and your therapist are shifting focus, this is what you can generally expect:
- Assessment, information gathering, and education– this stage will help your therapist better understand how OCD symptoms show up for you and how they impact your day-to-day life. Your therapist will also be teaching you more about OCD, the cycle or model of OCD, etc. to help you gain a better understanding of what you’re experiencing.
- Resourcing- if you’re new to EMDR, you can expect to cover this before processing. In this portion, you’ll be learning and developing ways to cope with emotions and various skills and resources to help assist with grounding and calming you down. Processing can be difficult and having some tools in your toolbelt will help you and your therapist feel more prepared to move forward with processing because you both know you have the tools to help yourself ground and regulate in case something comes up in processing.
- Setting up for using the Distancing Technique- you and your therapist will determine the targets to address in processing. Your therapist will likely help you identify the thoughts, images, sensations, and impulses that are related to your OCD. You may have things to target in processing in each of these categories but you also might not, neither is right or wrong, each person shows up differently!
- The Distancing Technique- you and your therapist will identify an adaptive coping statement to reinforce. Some examples of these statements include:
- “A thought is just a thought”
- “This is my OCD, it’s not me”
- “This image is not real, my brain is playing tricks on me”
Once you have an adaptive coping statement that works for you, you and your therapist will utilize slow bilateral stimulation (BLS) to help reinforce that statement. Essentially, the BLS will be conducted through either tapping with your hands, slow eye movements, hand buzzers, etc. You’ll be asked to think about that statement, do a set of BLS, and then your therapist will check in with you between sets on what you notice. Then you’ll go into another set of BLS, pause and check-in, go back into BLS, and so on, and so on. This is the magic of EMDR. The BLS helps your brain make sense of the information being focused on. You’ll notice throughout the set different thoughts, images, memories, body sensations, etc. This is all normal and a part of the process. By the end of even one session of this, you’ll notice that you’re believing that adaptive coping statement significantly more and you’ll also notice having more distance between yourself and your OCD symptoms.
- Homework- EMDR doesn’t typically include homework, but this is the exception. Your homework will be to practice your adaptive coping statement when you notice OCD symptoms flaring up. I usually encourage clients to write it on a Post-It note and put it somewhere they spend a lot of time, save it as a picture on their phone home screen, repeat it as a mantra throughout the day, etc. All this is to help reinforce this statement so it sinks deeper and deeper into your brain. (Note: you can make changes and adjustments to the adaptive coping statement as needed. This is a normal and even encouraged part of the process, so don’t be afraid to modify it if a different phrase seems more helpful!)
- Reevaluation and more processing- After utilizing the Distancing Technique, the next session you come to will likely include a check-in on how the processing went in session, how you felt following the appointment, and how the rest of the week went in regard to your symptoms and experiences. You may be asked to complete an assessment on your OCD symptoms to track progress. It’s likely that you’ll continue utilizing the Distancing Technique, modifying it, strengthening it, applying it to other OCD symptoms, etc. until a reduction in symptoms is noticed.
- Future Rehearsal- Once the adaptive coping statement is strengthened, you and your therapist will begin this part of the process, future rehearsal. Essentially, you’ll be utilizing slow BLS to process through challenging situations where your OCD symptoms are likely to be triggered. The goal is to help you feel calm in the face of these challenging situations without experiencing OCD symptoms. This starts with the two of you identifying situations in which your OCD symptoms typically flare up and then you will create a detailed step-by-step sequence of events that you’ll walk through in processing. Then, when you’re ready to start processing, your therapist will help you access a calm state using the resources acquired in the second step, “resourcing,” listed above. You’ll utilize the slow BLS while focusing on the first step of the sequence you created. Your therapist will lead you through this, having you perform the slow BLS, pause, reflect on what you notice, assess your sense of calm, and return to the calm place before the next step. You will move on from this step in your sequence once you’re able to tolerate that step and maintain your calm state. Your therapist will then direct you to the next step, repeating this process until the sequence is complete. The adaptive coping statement that has been strengthened in the above steps is utilized throughout this process to help you navigate your various challenging situations.
- Reevaluation- As noted in the above steps, your therapist will check in about how processing went the previous session, assess current symptoms, and use that as a gauge of what to work on in that session, either revisiting that challenging situation and continue processing or move on to the next. This is a collaborative process, so be sure to voice your concerns, wants, and wishes!
- Lapse/Relapse Prevention- the unfortunate reality of OCD is that it is entirely possible to diminish or even eliminate your OCD symptoms entirely and to experience a lapse or relapse during a particularly stressful time or experience. A lapse is a partial or brief return to symptoms while a relapse is a return to the same level of symptoms before treatment. While this would be understandably frustrating, it is completely normal. Think about how long your OCD symptoms have been reinforced, it makes sense that they may pop back up every now and then. Also, once one set of symptoms is cleared, your brain might bring up other symptoms that were underneath the surface now that one or more obsessions are cleared. To help with this, your therapist should help you establish a plan if you notice a return in OCD symptoms. The skills you have developed can be used to help you if/when a relapse happens and it’s highly encouraged that you bring in your supports to help with this process. We typically notice that if a lapse or relapse happens, the symptoms are typically quicker to treat because you already have the skills, and your brain knows how to use them so we just need to apply them to the new situation. Again, while this is so understandably frustrating and/or scary, it is a normal part of the process and it can be managed with skills or further treatment.
To Wrap Up
This protocol has been researched and studied and has been shown to be effective in reducing OCD symptoms. Using BLS helps your brain establish more adaptive, positive neural networks and heals the negative networks maintaining these various symptoms. This can be challenging work and may elicit a variety of emotions, memories, and even physical sensations. Healing these neural networks can bring up a lot of stuff! My hope is that you feel confident in the skills and resources you have developed with your therapist to be able to tackle any dysregulation that may come up. That being said, please, please, PLEASE tell your therapist if you’re getting overwhelmed, dissociative, or have any concerns at all. All of that is completely normal and your therapist will be able to work with you on making this process manageable and tolerable for you. Outside of the session, be sure to lean on your supports, practice your adaptive coping statement, and continue taking care of yourself. You got this!!