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Can EMDR help with Depression?

Eye movement desensitisation and Reprocessing (or EMDR) is a “neurodynamic” type of therapy which has been shown to be an effective treatment for Post-traumatic Stress Disorder (PTSD) and trauma related issues.  It also has a growing evidence base as a treatment for other anxiety disorders such as OCD, Social Phobia and Panic Disorder.

But with so many people also looking for help with mood related problems, the big question is can EMDR help with Depression?

Although there are some promising initial research findings to suggest EMDR can be an effective treatment for depression, we still need some robust research to be done before it can officially become a recommended treatment.  However, as we shall cover here, parallels between the development of depression and the development of PTSD suggest that EMDR may be an effective Depression treatment.

Why might EMDR be a treatment for Depression?

EMDR was developed as a treatment for Post-Traumatic Stress Disorder and is a really effective treatment for this.  In terms of treating PTSD, EMDR is distinctive in that it focuses upon using bilateral stimulation to allow the client who has experienced the trauma to approach a traumatic memory and, through something call Adaptive Information Processing, to make new associations between the memory and other parts of their psyche and memory.

A client of mine once likened it to taking a Berocca or Alka Seltzer tablet.  Your trauma memory is the tablet.  A big solid block of memory.  When we begin EMDR it is like taking our Alka-Seltzer Memory and dissolving it in a bucket of water.  The memory dissolves, softens and disperses, mixing in with other parts of the brain in which we actually do feel safe and ok.

Depression is different to PTSD.  Whereas in PTSD, the symptoms we experience are based around intrusive memories and flashbacks, a persistent sense of threat or vigilance and avoidance of things related to the traumatic event, in Depression we often see the opposite.

We might feel sad or hopeless.  We are often less active and more avoidant, alongside feeling more lethargic and tired.  In our heads, rather than having flashbacks or sudden traumatic intrusions, we instead have more negative thoughts about ourselves and the world around us and often engage in the cyclical thinking style of rumination.

In terms of presentation then, PTSD and Depression are significantly different.  However, just as in the way that PTSD has its origins in one or more traumatic life events, we also know that depression too can be triggered by emotionally challenging life events.  In depression, rather than triggering life events being related to a sense of threat to life (as in the case of PTSD), they are instead unrewarding and stressful and are often associated with themes of loss.  This could be observable things such as loss of a job, a relationship or a loved one or more pervasive things like loss of identity, purpose or direction.

When we get depressed, we often ruminate on why we feel so bad, and typically we will dwell on some of the events that have contributed to the onset of our depression.  All of these events can be a target for EMDR processing.  If we are able to desensitise and adaptively process these events (refer back up to our Alka seltzer metaphor) we will experience less distress when these memories occur and, logically, we will experience less distress in the here and now.

Further, desensitisation to painful memories can be useful when we look at the barriers to the depressed individual returning to previous levels of functioning.  Anyone who has ever tried to do Behavioural Activation for Depression might understand how some of the things that used to bring us pleasure, now fail to do so because they activate the memory of a loss or challenging event.  The client who used to love staring at the sunset with their partner for example, now avoids it because it reminds them of the pain of their separation.  The use of EMDR to change the intensity of these associations can be a beneficial addition to standard depression treatments.

Adverse Childhood experiences (ACEs) and Depression

Beyond the standard EMDR protocol, recent EMDR research has expanded into looking at the effects of early trauma and neglect upon later psychological problems.  The Adverse Childhood Experiences (ACES) literature robustly illustrated relationships between difficult childhood events and the development of both physical and psychological problems later in adult life.  This also holds true for Depression.

 

Multiple studies have found a relationship between emotional, physical and sexual abuse and an increased prevalence of lifetime depression, with some studies also suggesting that the more of these events a child experiences, the greater the possibility of them experiencing depression within their lifetime.  We could then hypothesise that EMDR focused upon resolution of these ACEs would lead to a reduction in the risk of developing depression and assist in its alleviation for current sufferers.

The evidence for EMDR as a treatment for Depression

Much of the evidence so far for EMDR as a treatment for Depression has come from small studies and individual case examples.  Although these have typically been fruitful and have led to a reduction in depression symptoms, there is still a need for larger scale studies on this theme.

As I write this there are developments with regards to generating the small scale feasibility studies which will precede the larger scale randomised Controlled Trials needed to strengthen the case for EMDR being a recommended treatment for depression.  Similarly there are other trials which have recently been covered which have looked at how EMDR can be used alongside existing treatments like CBT which are again proving to be promising.

Hopefully, if these trials are successful then we will have another great treatment to alleviate the suffering of depression.

George Maxwell
CBT and EMDR Therapist
June 2019

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