EMDR Shows Remarkable Promise For Post-Traumatic OCD Treatment

Many people explicitly connect their OCD symptoms with histories of trauma, and can distinctly trace the evolution of their obsessions and compulsions to specific moments in their lives in which they experienced overwhelming distress. Despite this, OCD has historically been treated in isolation, as a discrete disorder unrelated to traumatic events, leaving debilitating and painful symptoms unaddressed. Over the past decade, however, a growing body of research confirming the links between OCD and trauma has called the wisdom of this approach into question, and has led to a more nuanced understanding of post-traumatic OCD treatment. As Tori Rodriguez writes in Scientific American:

In a 2003 study of patients with [OCD and PTSD], psychiatrist Beth R. Gershuny of Bard College found that as OCD symptoms decreased with treatment, PTSD symptoms—such as flashbacks and nightmares—became worse. She more recently showed that 82 percent of treatment-resistant OCD patients reported a history of trauma, with 39 percent of those meeting the criteria for PTSD. A picture of the interplay began to emerge: if a patient’s past trauma is not addressed, targeting his or her OCD will not restore mental health.

A more recent study published in Journal of Anxiety Disorders found that “people with post-traumatic OCD tended to have a more severe collection of symptoms” than those whose OCD developed prior to trauma or those who did not have a history of trauma at all. These symptoms include heightened anxiety and depression, greater frequency of suicidal ideation, and increased severity of behaviors such as hoarding and compulsive spending. As such, it appears that not only does post-traumatic OCD require trauma-focused treatment, but that treatment must address these meaningful qualitative and quantitative symptomatological differences.

Unfortunately, the characteristics of post-traumatic OCD and the behavioral and thought patterns common to those who experience it create unique challenges to conventional psychotherapeutic modalities. Dr. Monnica Williams points out:

Although negative life events, such as a psychological trauma, can be the catalyst for the onset of the disorder, psychological exploration of these events [gained through insight-oriented therapy] is not curative for OCD. Unfortunately, insight alone is not enough. People with OCD tend to be introspective and typically have already spent a great deal of time and effort ruminating about the origins of their disorder. In fact, this sort of rumination can be a mental compulsion, which will actually worsen the symptoms.

As awareness of the limits of conventional treatments grows, mental health professional are increasingly turning to alternative routes for healing from post-traumatic OCD, that seek to address the roots of the disorder while offering viable pathways toward recovery.

Today, many researchers believe that Eye Movement Desensitization Reprocessing (EMDR), an integrative therapy originally designed to treat PTSD, may hold the key to recovery for those struggling with post-traumatic OCD. As Drs. Karsten Böhm and Ulrich Voderholzer write in their 2010 study:

[EMDR] conceptualizes psychological disorders as manifestations of unresolved traumatic or distressing memories. EMDR has been conceived as an integrative approach, aimed at facilitating resolution of memories, desensitizing stimuli that trigger present distress as a consequence of second-order conditioning, and incorporating adaptive attitudes and behaviours for better functioning.

In other words, EMDR doesn’t simply allow you to understand your OCD, but allows you to reprocesses traumatic memories to fundamentally change the way you relate to your trauma. This can potentially alleviate the obsessions and compulsive behaviors you engage in to cope with traumatic memories.

Research into the use of EMDR in post-traumatic OCD treatment has thus far yielded promising results. Dr. Böhm and Voderholzer found that EMDR reduced OCD symptoms by up to 60% and that patients “experienced EMDR as a useful and motivating method. Furthermore, they felt encouraged to deal with their emotions in additional psychological treatments.” A subsequent study on subjects with both post-traumatic and non-trauma related OCD had even more impressive outcomes, with all participants describing improvement within 2-3 sessions and reducing symptoms by up to 80% overall:

These individuals had suffered with disabling OCD for many years and had attempted various other CBT therapies without achieving any relief. After 14–16 adapted EMDR individual sessions, each participant reported significant symptom improvement and a large decrease in distress, with the effects of treatment maintained at 4–6 months follow-up. Each [participant] also made substantial changes in life function and activities, reaching and maintaining a number of important personal goals.

John Marr, author of this study, believes that part of the reason EMDR leads to such impressive outcomes is its highly customizable nature, which allows therapists to guide clients through a safe and structured therapeutic process that gradually addresses both acute, present-day triggers and historical traumatic events:

By dealing with individual triggers from the present, the underlying events often become apparent; they can even dissipate without being directly addressed. Related past incidents and touchstone events are revealed naturally during processing of the current triggers, and their meaning and relevance in the present life is apparent and diminished. The past distressing memories lose their strength and power and are more amenable to processing after the current OCD events are resolved.

For people who have struggled with treatment-resistant OCD that arose from trauma, the potential for personalization and impressive efficacy of EMDR offer extraordinary hope for recovery.