The August edition of the RCPsych Article of the Month features a series of four articles on Eye Movement Desensitisation and Reprocessing (‘EMDR’) therapy, published in BJPsych Advances. The articles are selected as article/s of the month, anticipating their impact on informing and updating everyday psychiatric practice. All four articles can be accessed here, alongside an accompanying podcast.

My journey into EMDR (Eye Movement Desensitization & Reprocessing) therapy was sparked by a poignant experience during my core psychiatry training in Ireland. A colleague, calling from England, shared a compelling case with me one evening. A patient on his ward faced the daunting task of testifying in court against her assailant. Gripped by fear, she was hesitant until her Consultant Psychiatrist suggested EMDR therapy and conducted it with her. The patient not only mustered the courage to attend court, also confidently gave evidence in court, marking a profound turning point in her recovery and resilience.

At that stage in my career, I was beginning to consider what kind of psychiatrist I wanted to be. Whilst psychiatry training can equip you with the knowledge and skills to treat depression, psychosis and so forth. At the end of those treatments, you are left with human beings who have been traumatised, at times, by the experience of being ill or by even treatment itself. So, what do you do?

Trauma is ubiquitous in every day life. Some we have control over and some we do not. Traumatologists often talk of Big “T” traumas and small “T” traumas. While Big T traumas may be associated with Post traumatic Stress Disorder and disability, small T traumas are equally important because they can chip at us, erode our self-confidence, peace and happiness such that when they pile up, or coalesce, the impact can be just as damaging as a single big T trauma.

Fortuitously, I secured funding to undergo training in EMDR. This decision proved transformative, both professionally and personally. During the training, one was encouraged to come with some form of mild or moderate trauma that one would like to work on, and I had one I really wanted to tackle. By the time, I returned to work the next Monday following the weekend of Part 1 training, the matter no longer upset me. It has remained a distant neutral memory to this day. I have actually grown as a result of that experience and used my growth to help others.

These, I think illustrates the power of EMDR therapy. It works faster than comparative trauma therapies and presents a real chance for post-traumatic growth. The metaphor I often use with my patients is that living with unprocessed traumas can be like travelling through the journey of life with a backpack full of heavy rocks. With EMDR, we can take out those rocks such that the journey becomes lighter and we can also replace those rocks with teddy bears so that the journey then forwards becomes enjoyable.

In hospital settings, we frequently encounter patients struggling with trauma-related issues that seem insurmountable. From MRI phobias to childbirth anxieties, having a tool like EMDR that can be readily deployed in these settings is invaluable. EMDR can be offered as a stand-alone therapy or adjunct to other interventions. It may work in as few as one session and can be provided in group format.

EMDR is sometimes met with skepticism among colleagues. Hence Part 1 of the series is an invitation to the reader to consider, for themselves, the evidence for efficacy of EMDR in PTSD. In Part 2, we present the evidences that supports its use in other mental health conditions. Expanding available treatments for depression is of necessity. Then in Part 3, we see that it is useful, not only for mental health conditions but also for physical health conditions.  

It is imperative for medical professionals to delve into the robust evidence supporting the therapeutic benefits of EMDR therapy, particularly in conditions beyond PTSD, such as depression and chronic pain syndromes. The compelling evidence supporting EMDR’s efficacy in trauma treatment warrants its integration into mainstream clinical practice.

These articles highlight the value of Eye Movement Desensitisation and Reprocessing Therapy: discussing evidence and practice in PTSD (part 1), therapeutic benefits in trauma and stress related conditions (part 2) and in physical health conditions such as chronic pain (part 3), unravelling untapped potential of EMDR therapy used on its own or as an adjunct. Integrating EMDR therapy in mainstream clinical interventions on offer to our patients is well advocated by the authors. This is followed through with an apt commentary by Paul Miller illustrating the evolution of EMDR therapy and its development as a front-line trauma focussed therapy. Itoro Udo has also provided a podcast interviewed by Oliver Gale-Grant and a blog on ‘Creating more pathways to wellness: harnessing EMDR therapy’, exemplifying these articles and for developing more training opportunities for an increased pool of EMDR practitioners.

Asit Biswas, Editor-in-Chief, BJPsych Advances

Read the four articles:

Eye movement desensitisation and reprocessing: part 1 – theory, procedure and use in PTSD
^{Itoro Udo, Tori-Rose Javinsky, Tuoyo Awani}

Eye movement desensitisation and reprocessing: part 2 – wider use in stress and trauma conditions
^{Tori-Rose Javinsky, Itoro Udo, Tuoyo Awani}

Eye movement desensitisation and reprocessing: part 3 – applications in physical health conditions
^{Itoro Udo, Tori-Rose Javinsky, Carol McDaniel}

The evolution and future of eye movement desensitisation and reprocessing therapy
^{Paul W. Miller}