OCD-EMDR Blog post

There is some research to suggest that OCD may be a response that develops as a consequence of adverse events in childhood. This is compatible with research suggesting that parents who were emotionally abusive or neglectful may have hampered the child’s ability to self-regulate or self-soothe (Mate, 2012; Parnell, 2013; Perry et al., 2018; Schore & Schore, 2007), thus laying the foundations for OCD. 

Shapiro (2001) introduced the concept of large-T and small-t trauma in EMDR. She describes the way that small-t traumatic events such as rejections, humiliations and disappointments in childhood can have lasting adverse effects. While these small-t traumas may not lead to the intrusive imagery that is common in PTSD, these events can still generate emotions, beliefs and physical reactions that lead to unhappiness, anxiety and/or maladaptive behaviours in the present. 

In keeping with Shapiro’s concept of small-t trauma, Parnell (2013) developed an attachment-based modification to the EMDR approach. Parnell proposed that, while EMDR is a powerful resource that allows clients to challenge feelings and thoughts with reduced activation, it is less effective for clients who have developed an insecure attachment style stemming from relational trauma in childhood such as abuse, neglect, abandonment or mistreatment. She suggests that these individuals are more likely to struggle when navigating the intense emotions that arise during EMDR and require a strong bond with their therapist. Parnell describes how the primary difference between EMDR and AF-EMDR is the latter’s focus on the importance of the therapeutic relationship, with an emphasis on attunement and the adaptation of the work to the individual’s needs.   

Parnell describes how individuals whose parents were inconsistent, unavailable or overly intrusive may feel shame that ‘there is something wrong with me’ and emphasises the need for these clients to have tools to calm their anxiety and soothe their self-criticism and shame. Parnell proposes that when clients develop positive self-talk to counter their negative thoughts, it has a calming effect on the right brain hemisphere and new neural pathways may be created. This is compatible with neuropsychological research suggesting that the right brain systems are relevant for attachment, affect regulation and developmental change (Schore & Schore, 2007; Siegel, 2003). Brayne (2024) concurs with Parnell’s view, proposing that the clients’ attachment-informed survival response is adaptive, formed in their early years, and will have implications for their presentation in the here and now. 

In this research, the intent was to use AF-EMDR interventions to help participants with OCD improve their ability to self-soothe. AF-EMDR emphasises the use of bilateral stimulation (BLS) to ‘install’ resources prior to processing, which should help this population self-regulate. It was hoped that this would, in turn, facilitate them in undertaking ERP activities. 

The qualitative interviews suggested that it was the AF-EMDR process overall, including the grounding exercises, that participants found beneficial. They were all receptive to the AF-EMDR conceptualisation of OCD, with the emphasis on childhood experiences and relationships. 

There was a high rate of engagement, with all participants finding the AF-EMDR treatment beneficial and asking to continue with treatment at the end of the study. This is interesting when considered in relation to the relatively high attrition rate for CBT treatment alone (Abramowitz, 2010).