Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychotherapy used primarily to treat post-traumatic stress disorder (PTSD). It helps the mind process traumatic memories that have become functionally “stuck.” Recognized globally for its effectiveness, a common concern is whether this intense process could potentially induce or trigger a psychotic episode. This article explores the relationship between EMDR and psychosis, clarifying the clinical understanding of the risks involved.
Understanding How EMDR Works
EMDR therapy is based on the Adaptive Information Processing (AIP) model, which posits that the brain naturally heals from trauma, but this process can be blocked by highly distressing events. When trauma occurs, the memory is stored dysfunctionally, retaining the original negative emotions, sensations, and beliefs. EMDR facilitates natural processing using bilateral stimulation, typically involving side-to-side eye movements, auditory tones, or alternating tactile buzzers.
This bilateral stimulation is thought to engage both sides of the brain, potentially mimicking the mechanisms of rapid eye movement (REM) sleep. By focusing on the traumatic memory while engaging in this dual attention task, the memory’s emotional intensity decreases. The memory then becomes integrated and stored like an ordinary life event, allowing the person to retain the memory without the associated psychological pain.
The Direct Answer on Psychosis Risk
Clinical consensus indicates that EMDR does not cause chronic psychotic disorders. It is considered a safe intervention, even for individuals who already have a psychotic disorder diagnosis with co-occurring PTSD. Addressing underlying trauma through EMDR has often been associated with a reduction in both PTSD and positive psychotic symptoms, such as delusions and hallucinations.
The concern about triggering psychosis stems from the potential for acute, transient destabilization during reprocessing. Activating a distressing memory can lead to intense emotional flooding, depersonalization, or derealization. These temporary adverse effects are typically brief and resolve within or shortly after the session with a trained therapist. EMDR may cause brief, psychotic-like experiences as trauma surfaces, but it does not initiate a sustained, chronic psychotic illness.
Identifying Vulnerability and Dissociation
The highest risk for acute destabilization during EMDR is observed in populations with complex trauma histories, such as Complex PTSD (C-PTSD). These individuals have often experienced prolonged traumas, leading to pervasive psychological symptoms. A particular vulnerability is high levels of dissociation, a common psychological defense mechanism against overwhelming trauma.
Dissociation involves a disconnection between a person’s thoughts, memories, feelings, or sense of identity. Rapid activation of traumatic material can overwhelm the client’s capacity to remain grounded, intensifying dissociative symptoms like feeling detached from one’s body. Moving too quickly without preparation can lead to a temporary, overwhelming sense of unreality or a feeling similar to a psychotic break. Therefore, therapists working with complex trauma must proceed with a modified and significantly longer preparation phase.
Clinical Safety Measures and Preparation
The EMDR protocol includes explicit safety measures to manage the risk of overwhelming a client. The first two phases, history-taking and preparation, are designed to build a foundation of stability before traumatic memories are actively reprocessed. This preparation phase is a primary safeguard against adverse reactions that could mimic or trigger a psychotic episode.
During preparation, the therapist screens the client to assess emotional regulation and dissociative tendencies. Clients are taught self-soothing and grounding techniques, which are internal resources for managing distress. These resources often include establishing a “safe place” visualization or a “container” exercise for temporarily holding distressing material. Reprocessing only begins once the client demonstrates sufficient skill to manage emotional distress, ensuring the process remains within their window of tolerance.