Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects millions of people around the world. The symptoms take a toll not only on the sufferers, but impact those surrounding them as well. While different therapeutic modalities have been used to sucessfully treat OCD, EMDR (Eye Movement Desensitization and Reprocessing) is emerging as a promising option. EMDR, which was originally designed to treat trauma, has been found to be particularly helpful for those affected by both OCD and PTSD (Post-Traumatic Stress Disorder). Numerous studies have shown that EMDR is beneficial for those suffering from trauma, especially for people who have been exposed to a single traumatic event. It is thought that OCD can be a result of trauma and that the OCD symptoms can be resolved by addressing the root cause.
What is OCD?
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by the presence of obsessions (unwanted, unnecessary, and intrusive thoughts or sensations) and compulsions (repetitive, irrational and often ritualistic behaviors that alleviate the anxiety that stems from the obsessions). Common themes in OCD include obsessions about cleanliness, order, time, appearance, and maintaining patterns. For example, a person fixated on cleanliness may spend an excessive amount of time cleaning, wash his/her hands repeatedly, or refuse to touch anything seen as “contaminated”. Being unable to engage in the compulsive behaviors (ie. hand washing) which sufferers see as a remedy to their fears results in increased stress, anxiety and even anger. People with OCD typically recognize that their fears and behaviors are irrational. However, they typically struggle to control their symptoms and become trapped in a vicious cycle. As they continue to engage in compulsive behaviors, their obsessions are reinforced and the pattern becomes more and more deeply entrenched. The severity of the condition ranges from mild to major impairment. In the most serious cases, people are consumed by their obsession and compulsions, leaving little time or energy for anything else. This disorder can impact a person’s life on a variety of levels, including socially, educationally, occupationally, and financially, as well as mentally, emotionally, and spiritually. Sometimes it can be difficult to distinguish between problematic habits and OCD.
Psychologists define OCD by the following criteria:
-At least an hour of the day is spent on the compulsion
-Not engaging in the compulsive behavior causes stress and anxiety
-The person does not feel in control of the obsessions/compulsions
-The symptoms cause negative consequences in work, social, or personal life
PTSD and OCD
Psychologists and physicians do not know what causes OCD. They have, however, identified numerous risk factors contributing to its development. A history of trauma is one such risk factor, so it is not surprising that 30% of people suffering from PTSD also have OCD. Other risk factors include a family history of OCD, depression, anxiety, and physical changes in the brain. While more research is needed to understand the connection between PTSD and OCD, practitioners believe that trauma can trigger OCD-like symptoms. Both conditions may stem from unresolved traumas, such as a car accident, surviving a natural disaster, witnessing a crime, being exposed to war, being sexually or physically assaulted, or experiencing the death of a loved one. The presentation and severity of the symptoms will vary from case to case, but there appears to be a strong link between the two. The fact that both OCD and PTSD are anxiety provoking conditions may help explain the psychological and physiological connection.
Many patients with OCD claim that their symptoms started after a traumatic event. Interestingly, one study from the Journal of Anxiety Disorders found that people who developed OCD following a trauma had more severe symptoms than those with OCD prior to or without any occurrence of trauma.
PTSD is a serious disorder by itself. People suffering from this condition may have a chronic sense of fear or unease, relive traumatic experiences via flashbacks or nightmares, and have difficulty letting go of the past and moving forward with their lives. When this is coupled with the obsessions and compulsions of OCD, the severity of the condition is multiplied. This makes the person more vulnerable and susceptible to stress.
Can EMDR Help With OCD?
Once we understand that it is not uncommon for OCD to manifest after a trauma, it seems reasonable that a therapy designed for PTSD may also be effective in treating OCD. Some studies suggest that EMDR can benefit people with post-traumatic OCD e.g. war veterans. One study in the International Journal of Psychotherapy identified positive outcomes from using EMDR therapy for individuals with post-traumatic OCD. Study participants reported a reduction in stress, anxiety, obsessions, and compulsions.
The most common and empirically validated treatment for OCD is Cognitive Behavioral Therapy (CBT), a modality in which patients work on becoming aware of their thoughts and behaviors and learn to modifying them into adaptive patterns. There is also a specialized form of CBT specifically designed for OCD called Exposure and Ritual Prevention (ERP). ERP involves having a patient with OCD directly confront their fear (ie. someone afraid of contamination may have to touch a door knob or toilet seat without gloves). When the patient engages in the fear-provoking behavior and does not experience the anticipated negative consequence, the vicious cycle starts to break down. This is the most common treatment for OCD and is known to be highly effective.
One randomized controlled trial published in Clinical Psychology and Psychotherapy compared EMDR with CBT in the treatment of OCD. The results from this study showed comparable results from the two therapies. There was no significant difference between the outcomes of the two groups, both immediately after the study and at a six month follow-up.
Though these studies do not explain how EMDR treats OCD, they do show favorable results. It is further evidence that EMDR can help treat OCD, specifically in patients who have a history of trauma.
There’s a strong possibility that EMDR therapy treats OCD symptoms the same way it works for PTSD- by targeting the traumatic memories and how the brain perceives and stores them. Because of the strong connection between the two conditions in some patients, treating one may naturally alleviate the other. For those with difficult to treat OCD, a combination of CBT and EMDR may be helpful.
EMDR Options for OCD
There is strong empirical evidence indicating that EMDR is effective in treating both PTSD and OCD. There is also anecdotal evidence in which many patients with both trauma histories and OCD symptoms report improvements. This makes EMDR a promising treatments for this population.
EMDR is typically facilitated by therapists who have been trained in EMDR. (These therapists may or may not be certified by EMDRIA, the EMDR International Association.) This modality includes eight phases that go beyond the eye movements themselves. The process is carried out over the course of eight or more sessions of up to 90 minutes. While it is best to work with an EMDR therapist, this may not always be possible. There may be a lack of access to trained therapists or possibly financial barriers. The good news is that EMDR can be self-administered. Virtual programs such as VirtualEMDR (read our review) provide audio and video guides, as well as controlled bilateral stimuli. VirtualEMDR is designed to deliver the exact protocol used by therapists during in-person or online sessions. The tool utilizes the same stages and procedures, allowing individuals with PTSD and OCD symptoms to engage in the therapy from the comfort of their own homes. The accessibility, flexibility, and affordability of the virtual program means that more people can benefit from EMDR by treating their mental health symptoms and improving their quality of life.
If you suffer from OCD, it is best to consult with a mental health professional to determine if your OCD symptoms originate from a traumatic event. If you are suffering from post-traumatic OCD, EMDR can be immensely beneficial.
There is mounting evidence (both anecdotal and research based) that EMDR is an effective treatment for OCD. EMDR has long been hailed as a quick, efficient, and effective way of addressing PTSD that results from a single traumatic incident. For those also suffering from trauma induced OCD, EMDR can also be beneficial in treating the OCD symptoms. ERP is considered the most successful treatment for OCD; it is possible that combining EMDR with ERP could have a synergistic effect and further improve patient outcomes.