Eye Movement Desensitization and Reprocessing (EMDR) and Exposure and Response Prevention (ERP) are two evidence-based therapies commonly used to treat trauma and anxiety disorders like PTSD, OCD, and phobias.
But can you safely and effectively do both therapies simultaneously?
This article examines the key considerations.
Overview Of EMDR And ERP
EMDR utilizes bilateral stimulation like eye movements or taps while recalling traumatic memories to reprocess them.
ERP incrementally exposes patients to anxiety-provoking stimuli to decrease fear.
Both aim to reduce avoidance and distress related to triggers. But their approaches differ significantly.
Key Differences
| EMDR | ERP |
|---|---|
| Targets past memories to reprocess emotions/beliefs | Exposes patient to real-life triggers to tolerate uncertainty |
| Shorter treatment duration | Usually a longer treatment plan over months/years |
| Less homework between sessions | Relies heavily on daily exposure practice |
Can EMDR And ERP Be Combined?
There are mixed opinions on combining both treatments simultaneously:
Arguments For Combining
- May have an additive effect in reducing trauma symptoms
- Maximizes progress by using multiple evidence-based therapies
Arguments Against Combining
- Risk of overloading or overwhelming patient
- Too cognitively/emotionally taxing
- Therapies have conflicting procedures
Clinicians hesitate to combine without more research on interactions.
Key Considerations For Combined Treatment
If attempting to combine EMDR and ERP, several factors should be addressed:
Patient Fit
Ensure patient has adequate distress tolerance and ego strength to handle intense exposure work without becoming destabilized.
Treatment Order & Timing
Strategically time interventions so not concurrent. E.g. Have daily ERP practice, and weekly EMDR session.
Monitoring Progress & Distress
Closely monitor patient functioning to adjust treatment based on response. Measure baseline symptoms pre/post each modality.
Clinician Expertise
Provider should have extensive training in both modalities to competently integrate approaches.
Consistent Rationale & Psychoeducation
Explain to patient how therapies complement each other and reduce confusion about conflicting procedures.
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Bottom Line
While research is still limited, some clinicians report carefully combined EMDR and ERP can amplify progress for well-suited patients.
However, blending treatments requires expertise in both modalities and close patient monitoring.
More data is still needed on interactions and timing strategies before formal guidelines can be made.
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