EMDR and OCD: An Innovative Approach

Obsessive-Compulsive Disorder (OCD) is a often severely disabling psychiatric condition characterized by:

• obsessions — intrusive, recurrent thoughts, images, or impulses
• compulsions — repetitive mental rituals or behaviors aimed at reducing anxiety

Prevalence is classically estimated at around 2% of the general population, making it a common disorder. In terms of impact, OCD is associated with significant suffering and impaired quality of life; it was historically classified among the most disabling conditions in WHO/GBD assessments during the 1990s and 2000s. (ScienceDirect)

1) The limits of first-line treatments

The reference approaches remain:

• CBT with Exposure and Response Prevention (ERP)
• SSRIs (serotonin reuptake inhibitors)

These are effective for many people – but not for everyone. In real clinical practice, a major challenge is adherence: ERP can be demanding, and studies report non-negligible attrition rates (meta-analyses suggest around 15-20% depending on the sample and definitions). It is precisely in these situations – intense distress, avoidance, therapeutic deadlock, “I understand but I can’t do it” – that an approach like EMDR can become a meaningful lever.ur de ~15-20% selon les échantillons et définitions). (PubMed)

2) Why EMDR can help in OCD: the AIP model applied

EMDR (Eye Movement Desensitization and Reprocessing) is grounded in the Adaptive Information Processing (AIP) model: when certain experiences remain insufficiently integrated, they continue to fuel automatic emotional and somatic responses.

OCD as a stuck alarm system

Neurobiological research commonly describes OCD through dysfunction of cortico-striato-thalamo-cortical (CSTC) loops, involved in inhibitory control, error detection, and stop signals. In practical terms: the brain over-detects risk and error (“what if…?”) and struggles to stop the loop (“I checked, but it’s not enough”).

The role of life experiences (large-T and small-t traumas)

OCD is not necessarily triggered by a major traumatic event. But emotionally charged experiences are frequently found in the history:

• shame, criticism, humiliation
• early excessive responsibility
• family unpredictability, a sense of fault
• stressful life events

In an AIP framework, these experiences can become “root memories”: they subsequently color the obsession (danger, guilt) and justify the compulsion (relief, neutralization).

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3. What the clinical data show: promising but still consolidating evidence

EMDR is not yet a first-line treatment for OCD in international guidelines. However, several bodies of work support its value.

EMDR vs. medication (SSRI) 
Nazari et al. (2011): a randomized controlled trial comparing EMDR to citalopram in OCD patients found significant short-term symptom improvement favoring EMDR. (PubMed)

EMDR vs. behavioral therapy 
Marsden et al. (2017/2018): a randomized trial comparing EMDR and CBT (including ERP-adjacent strategies) found comparable outcomes between groups, maintained at 6 months. (PubMed)

Clinical studies and protocol adaptations 
Case series and clinical work on EMDR adaptations for OCD – including the approach developed by John Marr – describe sometimes marked improvements in individuals who had reached a therapeutic impasse. (EMDR)

A key caveat: results are encouraging, but larger trials and more standardized comparisons are still needed (OCD subtypes, comorbidities, combination with ERP and SSRIs).

4) Why OCD requires adaptations: the self-sustaining cycle

In a “classic” trauma, there is often an identifiable source event. In OCD, the problem is typically:

• cyclical — obsession → anxiety/disgust → compulsion → relief → reinforcement
• present-centered — current triggers are omnipresent
• driven by intolerance of uncertainty and thought-action fusion

Hence the core principle: not only reprocessing the past, but also desensitizing what is happening in the present.

5) EMDR protocols and innovations specific to OCD

A) The Marr protocol: starting with the present (and dismantling the ritual)

Marr proposes an inverted logic: targeting current triggers first (the obsession and compulsive urge) as EMDR targets, before tracing back to historical roots. (EMDR)

Video playback technique: The patient mentally replays the ritual sequence as though watching a film; whenever a peak of anxiety or disgust arises, processing stops and that fragment is treated with bilateral stimulation (BLS). This breaks the emotional charge down into tolerable units. (EMDR)

B) The Flash-forward procedure (Logie & de Jongh): targeting the anticipated catastrophe

Particularly useful in OCD where the obsession says: “If I don’t perform the ritual, X will happen.” The flash-forward targets the image of the future catastrophe (fire, fatal contamination, accident, moral ruin) and desensitizes the anticipation. (Hornsveld Psychologen Praktijk)

A key point: pushing all the way to the “worst of the worst” (loneliness, helplessness, irreparable guilt) and then reprocessing the associated imagery and beliefs.

C) Distancing (Krentzel & Tattersall): becoming a detached observer

Objective: Reducing the fusion between thought or urge and reality (“if I think X, it is dangerous / true / imminent”). The distancing approach teaches labeling — “this is my OCD” — and builds an internal observational stance, while reprocessing triggers. (spj.science.org)

D) OCD as an “emotional part”: a dissociative lens useful in rigid presentations

Some clinicians conceptualize OCD as a highly rigid protective part: it imposes rules to prevent shame, fault, or moral catastrophe. In this framework, the aim is less to “fight the symptom” than to:

• understand its protective function
• build internal alliance
• reprocess what it is trying to prevent (most often affects of shame, guilt, and fear)

This approach articulates well with structural dissociation theory and stabilization strategies when the system is fragile.

6) The eight-phase EMDR protocol – with OCD-specific points of vigilance

The eight EMDR phases (Shapiro) remain the backbone. In OCD, the key differences lie primarily in preparation and titration.

1. History-taking: Identifying OCD themes and root memories (shame, responsibility, criticism, “I nearly caused a catastrophe”).
2. Preparation: Often extended. Psychoeducation (CSTC loops), stabilization, resource building, window of tolerance work.
3. Assessment: Target = the worst moment of the obsession or compulsion (or flash-forward). SUD, negative cognition (“I am dangerous”), positive cognition (“I can tolerate uncertainty”).
4. Desensitization: Short, titrated BLS sets to avoid overwhelm and rumination.
5. Installation: Reinforcing the positive cognition (VoC).
6. Body scan: Processing somatic residues (tension, disgust, tightness).
7. Closure: Return to calm, post-session anti-ritual plan if needed, grounding strategies.
8. Re-evaluation: Checking maintenance, new triggers, adjusting targets.

7) What EMDR concretely changes for the patient

Integration into a broader treatment plan

EMDR does not necessarily replace ERP or SSRIs – it often prepares the ground. A typical example: a person understands ERP intellectually but panics too quickly to engage with it. EMDR reduces the emotional load (shame, guilt, disgust, terror), making exposure finally workable.

Possible transient effects

As with any reprocessing therapy: fatigue, vivid dreams, amplified emotions for 24-72 hours, heightened sensitivity. This underscores the importance of solid preparation, an adapted pace, and a stabilization plan.

Frequently targeted OCD themes

• 🧼 Contamination / washing: “Dirty = danger / death / fault.
• 🔑 Checking / responsibility: “If I miss one detail, I destroy everything”
• 💭 Intrusive thoughts (Pure-O): Shame, fear of being “bad” or “dangerous”
• 📐Perfectionism / order: Absolute control to prevent collapse.

8) Conclusion: a realistic message of hope

OCD can be tenacious — but it is not a prison. Current evidence suggests that EMDR:

• can produce rapid relief in certain profiles
• offers an alternative or complement when ERP is intolerable
• works in depth on the emotional roots (shame, guilt, fear, disgust) that sustain the cycle

Research continues to evolve, but one thing is already clear: for people who are “stuck” in their treatment journey, EMDR represents a serious option worth discussing with a clinician trained in both OCD and EMDR. (PubMed)

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📚 References (selection)

• Nazari H. et al. (2011). EMDR vs citalopram dans le TOC. (PubMed)
• Marsden Z. et al. (2017/2018). Essai randomisé EMDR vs TCC, suivi 6 mois. (PubMed)
• Marr J. (2012). Adaptations EMDR pour le TOC, “video playback”. (EMDR)
• Logie R. & de Jongh A. (2014/2015). Procédure “Flashforward”. (Hornsveld Psychologen Praktijk)
• Krentzel C.P. & Tattersall J. (2024). Distancing Approach. (spj.science.org)
• Neurobiologie du TOC (boucles CSTC). (PMC)
• Attrition en ERP (revue/méta-analyse). (PubMed)