EMDR for OCD

EMDR is not a NICE-recommended treatment for OCD. What NICE recommends is CBT including exposure and response prevention, and SSRIs, in a stepped model depending on how much the OCD is wrecking your life. That is the guidance, it has been the guidance for years, and EMDR does not appear in it.

If someone has offered you EMDR therapy for OCD, they may still be doing something reasonable. But you should know where you are standing before you decide.

What OCD is, and what actually treats it

OCD is obsessions and compulsions. Obsessions are the intrusive, unwanted thoughts, images or urges: contamination, harm, symmetry, blasphemy, the fear that you have done something terrible and forgotten. Compulsions are what you do to make the feeling stop: washing, checking, counting, repeating, praying, mentally reviewing.

The compulsion works. That is the trap. It brings the anxiety down, briefly, and in doing so it teaches your brain that the obsession was a genuine emergency and the compulsion was what saved you. Every time you check, you make the next check more necessary.

Exposure and response prevention breaks that loop directly. You expose yourself to the thing that triggers the obsession, and then you do not perform the compulsion. You sit in the anxiety and let it come down on its own, which it does, and your brain learns that the emergency was not an emergency.

ERP is horrible and it works. It is the best-evidenced psychological treatment for OCD by a long distance.

NICE's model is stepped. Low-intensity CBT including ERP for mild impairment. For mild or moderate impairment where that has not worked, a choice of an SSRI or more intensive CBT including ERP, because those appear comparably effective. For severe functional impairment, combined SSRI and CBT including ERP.</cite>

That is the map. Anything else is off it.

Why anyone is trying EMDR at all

Here is the argument, and it is not stupid.

A meaningful proportion of people do not respond adequately to ERP. Some cannot tolerate it and drop out. Some complete a full course and remain unwell. OCD is a chronic, relapsing condition and the first-line treatment, good as it is, is not good enough for everyone.

And there is a real literature on the overlap between trauma and OCD. Researchers have developed instruments specifically for mapping it, including an OCD trauma timeline interview designed for clinical use. Adverse experience appears more often in the histories of people with OCD than chance would predict.

If you take EMDR's own model seriously, the logic follows. A distressing experience gets stored badly. It keeps generating the beliefs, the affect and the felt sense that were present when it happened. If the belief laid down was "I am contaminated", or "I am dangerous", or "if I am not vigilant something terrible will happen and it will be my fault", then the obsession is a symptom of a memory, and the compulsion is the management strategy.

On that account, ERP treats the loop and EMDR treats what feeds it. You could see why someone would want to try.

What the evidence actually shows

Thin. That is the honest word.

<cite index="23-1">A systematic review in 2021 examined nine studies on EMDR for OCD, including case studies and controlled trials, and reported significant symptom reduction. Some small studies found improvements comparable to ERP or to SSRIs. But the evidence remains limited. A 2024 case series reported that attachment-focused EMDR alongside CBT improved OCD symptoms. The current picture supports EMDR being used alongside ERP or CBT in some cases, particularly where past trauma or worst fears are part of the presentation.</cite>

Read what that is. Nine studies including case studies. A case series. Small trials.

Compare it to the OCD literature proper, which contains large network meta-analyses and decades of randomised controlled trials. It is not a fair fight, and pretending it is one does nobody a service.

The claim that EMDR performed comparably to ERP in some small studies is the sort of finding that gets amplified into a headline and then quietly fails to replicate. It might replicate. It has not yet been tested at the scale that would tell us.

I want to be careful here, because there is material in circulation citing specific journals and specific studies showing EMDR reducing OCD symptoms in treatment-resistant cases. Some of it is real and some of it is loosely sourced. If a clinic quotes you a study, ask for the citation and look at how many participants it had.

Where EMDR could reasonably sit

The defensible version is adjunctive and it is narrow.

You have OCD. You have done a proper course of ERP with a therapist who knows what they are doing. It has not worked, or it worked and then unravelled, or you could not engage with it at all. And there is identifiable trauma in your history that keeps surfacing, that seems connected to the content of your obsessions, and that ERP has not touched.

In that situation, processing the trauma alongside continued OCD treatment is a reasonable thing to try.

That is not "EMDR for OCD". That is "EMDR for the trauma of a person who also has OCD, in the hope that it makes the OCD treatment work better".

The difference matters, because it determines what happens next. If EMDR reduces your OCD symptoms, wonderful. If it does not, you have still processed some trauma, which is worth doing on its own terms, and you go back to ERP.

The specific risk with OCD

Now the part that concerns me most, and which I have not seen discussed enough.

OCD has an appetite for anything that resembles reassurance.

Think about what the disorder actually does. It presents you with a doubt, and it demands certainty, and any activity that promises to resolve the doubt gets recruited as a compulsion. Mental reviewing is a compulsion. Confessing is a compulsion. Researching your symptoms online at two in the morning is a compulsion. Asking your partner for the ninth time whether you locked the door is a compulsion.

An hour spent going carefully through a distressing memory, examining it in detail, checking how you feel about it, rating your distress out of ten, and doing it again next week, is an activity that OCD can absorb without difficulty.

I am not saying that is what EMDR is. But I am saying that a person with OCD can turn almost any therapeutic activity into a compulsion, and a therapist who does not know OCD may not spot it happening.

If the eventual effect is that you have found a more sophisticated way to seek reassurance, you have not been helped. You have been given a better-appointed room to do the same thing in.

This is the single strongest argument for insisting that whoever treats you knows OCD specifically, not just EMDR.

What to ask

Are you offering this instead of ERP, or alongside it? Instead of is a red flag, and a large one.

Have I actually had a proper course of ERP? Not six sessions of general CBT. Actual exposure work. A lot of people believe they have failed ERP when what they have failed is a diluted version of it.

What is your training in OCD? Not your EMDR training. OCD.

How will you tell the difference between processing and compulsive reassurance-seeking? If the therapist does not immediately understand why you are asking, that is your answer.

And what evidence are you relying on? A good clinician will say that the evidence is preliminary and that this is worth trying because ERP has not worked. A bad one will tell you EMDR treats OCD.

Where this leaves you

If you have OCD and you have not had ERP, get ERP. It is unpleasant and it works and it is what NICE recommends and it is available on the NHS. Do not spend two years on something promising and unproven while the well-evidenced treatment sits on a shelf.

If you have had ERP properly and it has not worked, you are in a genuinely difficult position, and the honest situation is that nobody has a great answer for you. EMDR is one of several things worth trying, particularly if there is trauma in the picture. It is not a solution. It is a reasonable next thing.

If someone is selling EMDR to you as a treatment for OCD, without ERP, without OCD-specific training, on the basis of a handful of case studies, then they are ahead of the evidence, and OCD is a condition where people already lose years to the wrong treatment.

You have probably lost enough time already.

This is general information, not clinical advice. If you have OCD, speak to your GP. In many parts of England you can self-refer to NHS Talking Therapies for CBT with ERP. OCD-UK and OCD Action both offer support and information. If you are in crisis, contact NHS 111 or Samaritans on 116 123.

References

National Institute for Health and Care Excellence. (2005, surveilled 2019). Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31). https://www.nice.org.uk/guidance/cg31

Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.

Wadsworth, L. P., et al. (2023). Understanding the overlap between OCD and trauma: development of the OCD trauma timeline interview (OTTI) for clinical settings. Current Psychology, 42, 6937–6947.