Can You Do EMDR And ERP At The Same Time?

Written By

Dr. Michael Nazir


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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

Targets past memories to reprocess emotions/beliefsExposes patient to real-life triggers to tolerate uncertainty
Shorter treatment durationUsually a longer treatment plan over months/years
Less homework between sessionsRelies heavily on daily exposure practice
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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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About the author

Dr. Michael Nazir

Dr. Michael Nazir

I’m a medical professional and psychologist based in Sweden, with 11 years of experience in the field. I’m dedicated to improving our understanding of mental health and developing effective interventions. Through my work, I strive to positively impact the lives of individuals and communities affected by mental health challenges.

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