By Dr. Christian R. Komor
OCD Recovery Center
Eye movement Desensitization and Reprocessing (EMDR) is not normally thought of as playing a role in the treatment of Obsessive Compulsive Disorder or it's sister OC-Spectrum disorders such as Hypochondriasis, Body Dysmorphic Disorder, etc. EMDR was developed in the 1980s by psychologist Francine Shapiro and her colleagues as a method of "accelerated information processing" (Shapiro, 1995). Although EMDR is often used in general clinical practice, its primary use is in the resolution of psychic trauma. Prototypical examples would be child abuse counseling or debriefing of victims of violent crime or environmental disaster. Magnetic Resonance Imaging (MRI) scans of the brain during the EMDR procedure have shown that it is associated with activation of the limbic system of the brain which is believed to be a center for the processing of emotionally significant psychic material.
In early 2000 our Clinic began experimenting with the use of EMDR in what we believe is a novel fashion not reported elsewhere in the literature which we will refer to as EMDR-Facilitated Habituation (EMDR-FH). While our experiences have been at the level of case studies, the positive findings that have emerged seem to warrant more standardized investigation in a research setting.
Like many clinicians working in the area of OC-Spectrum disorders we make periodic use of in vitro habituation via guided imagery. Briefly, this involves having the patient imagine a real-life location or situation, which triggers their obsession(s) with the goal of habituating to the anxiety aroused by the imagery. For example, a patient who is AIDs phobic may visualize sitting in a waiting room in their local Emergency Room. While not a substitute for in vivo exposure and response prevention (ERP) behavioral therapy experiences, this form of habituation seems to result in some degree of modification in the strength of obsessions probably via feedback into the frontal sub-cortical circuitry of the brain (Schwartz, 1998).
Our idea has been to combine in vitro habituation guided-imagery exercises with EMDR stimulation. For example, as the above patient experiences the peak in anxiety while imagining being seated in the Emergency Room we would begin the left-right lateral eye movements which are the hallmark of EMDR. We would ask the patient to track our hand (or another visual or auditory stimulus) from left to right and back again in sets of 25-50 movements. Our experience thus far has been noteworthy. The EMDR appears to accelerate the rate and depth of anxiety processing making the in vitro exposure less arduous for the patient and strengthening the habituation effect significantly. It is as if the EMDR "supercharges" the in vitro habituation process while lessening the discomfort for the OCD sufferer. Although we have not attempted this, it is possible that EMDR could also be used to accelerate in vivo exposure sessions as well, with the therapist accompanying the patient to a feared situation and invoking the EMDR eye movements during the habituation process.
While we have great respect for the power and efficacy of pharmacologic and behavioral therapies for the alleviation of OC-Spectrum disorders, our Clinic has been invested in exploring augmentative non-drug methodologies. We have observed that success rates for ERP and SRI drug treatments are less than might be desired and that lifestyle changes and self-care procedures have been underemphasized in the research and popular literature. Perhaps the EMDR-FH augmentation strategy described herein will serve to remediate this situation to some degree.
Several important caveats are in order concerning this proposed procedure. First, some individuals do not respond to EMDR. The literature does not provide a clear explanation for this. Second, like surgery, EMDR is a relatively invasive procedure. While seemingly straightforward and benign to the causal observer, EMDR can, when used incorrectly, lead a patient into panic, shock or other complications. This procedure should never be attempted except under the direct care of a licensed professional certified in EMDR use who is also trained and experienced in conducting cognitive-behavioral therapy with OC-Spectrum patients.
Clearly research is needed into EMDR-Facilitated Habituation (EMDR-FH) and we encourage other clinicians with research funding to pursue this interesting new technology for OC-Spectrum recovery enhancement.
Schwartz JM. Neuroanatomical aspects of cognitive-behavioral therapy response in obsessive-compulsive disorder. British Journal of Psychiatry 1998;193: 39-44.
Shapiro F. Eye Movement Desensitization and Reprocessing. New York, NY: Guilford Press; 1995.
Copyright 2000 by Christian R. Komor, Psy.D.