Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT) are two popular forms of psychotherapy used to treat conditions like post-traumatic stress disorder (PTSD), anxiety, and depression.
However, while both therapies are effective, many have wondered whether EMDR and CBT can be safely and effectively administered concurrently.
Overview of EMDR and CBT
EMDR focuses on replacing distressing thoughts about past traumatic or negative events with more positive perspectives.
The goal is to process and resolve these emotional disturbances that occurred in the past so clients can lead healthier lives in the present.
- A key part of EMDR is the bilateral stimulation process where clients move their eyes back and forth while recalling distressing events.
- This is believed to mimic rapid eye movement (REM) sleep and facilitate accelerated information processing in the brain.
On the other hand, CBT aims to modify dysfunctional emotions, behaviors, and thought patterns in the present.
CBT helps clients recognize negative or inaccurate ways of thinking to view challenging situations more clearly and respond to them more effectively.
While both therapies aim to reduce distress, they have fairly distinct approaches and areas of focus.
Can EMDR and CBT Be Used Together?
Many therapists argue that EMDR and CBT should not be used together during the same sessions or treatment timeline.
Several concerns and considerations around combining these therapies include:
- Too mentally demanding for clients: Processing traumatic memories during EMDR while simultaneously trying to alter thought patterns with CBT may be cognitively exhausting and overwhelming for clients.
- Interference: Alternating focus between past traumas and present thoughts could disrupt the efficacy of both therapies. For example, EMDR aims to process memories while CBT encourages detachment from those memories. Simultaneous use could send mixed, confusing messages to clients’ brains.
- Incompatible orientations: As previously described, EMDR and CBT rely on contrasting psychological frameworks and mechanisms of action. Using them concurrently could hinder their effectiveness.
- Lack of evidence and clinical guidance: No standard guidelines exist around best practices for integrated EMDR-CBT therapy. Without empirical clinical research, therapists risk providing inappropriate or contraindicated treatment.
Potential Risks of Combining Therapies
Without careful administration by an experienced professional, using EMDR and CBT together may jeopardize successful outcomes. Specific dangers include:
- Worsening symptoms: Overloading clients with dual therapy modalities could trigger further anxiety, emotional numbness, dissociation or re-traumatization.
- Undermining treatment: Rapid switching between EMDR’s trauma focus and CBT’s present-centered techniques may lead to client confusion, stalled progress or beliefs that “nothing works” in overcoming their mental health challenges. This false perception impedes future treatment effectiveness.
- Misapplication: Well-intended but underqualified therapists may improperly administer combined protocols. This heightens the likelihood of clinical errors that place already emotionally-vulnerable clients at greater risk.
This table summarizes some of the key differences between EMDR and CBT:
| Therapy | EMDR | CBT |
|---|---|---|
| Primary Focus | Processing past memories and trauma | Modifying dysfunctional thoughts and behaviors in the present |
| Key Techniques | Bilateral stimulation (eye movements), associative processing | Cognitive restructuring, exposure therapy, homework assignments |
| Treatment Structure | Less structured and directive | Highly structured and directive |
| Duration | Typically shorter-term | Can be short-term or long-term |
| Self-practice Required? | No | Yes, CBT requires practice of techniques at home between sessions |
| Ultimate Goal | Trauma resolution and relief from distress | Skill building to manage present challenges |
These differences showcase why layering the therapies simultaneously could be problematic.
However, used in a sequential approach, they may be able to complement each other in helping clients overcome trauma-related mental health conditions.
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Next Steps If Considering EMDR Plus CBT
The bottom line is EMDR and CBT should not casually be used together without careful forethought and planning.
However, in certain clinically-appropriate situations, some therapists argue judicious combined use may benefit select patients.
If entertaining simultaneous EMDR and CBT, first have an open discussion with your therapist. Key questions to ask include:
- What specific symptoms would this dual approach treat?
- How will you prevent interference between modalities?
- What precautions will you take to avoid risks like worsening trauma symptoms?
- What specialized EMDR plus CBT training have you undergone?
While research remains limited, some therapists also argue a phased approach to EMDR and CBT – with EMDR used first to target past trauma, followed later by CBT for present issues – may hold promise for certain patients.
But proceeding with caution and clarity is advised.
Conclusion
In summary, most experts and best practices suggest EMDR and CBT should not be used concurrently during active psychotherapy.
Using these distinct therapies together without empirical clinical evidence, strict protocols, and specialist-level training could negatively impact outcomes, slow progress, or potentially re-traumatize emotionally vulnerable clients.
However, in specific situations, some argue a strategic, phased approach under an extensively trained therapist may benefit select patients.
If exploring combined EMDR-CBT treatment, have an open, thorough risk-benefit conversation with your provider first.
But temper expectations that both modalities can safely and effectively be administered together.
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