EMDR vs. CBT
Which is More Effective?
EMDR vs. CBT; which treatment is better? That is a question hotly contested in the medical community. Is one better than the other? Or, could a combination of the therapies work best? This article will explore those questions and how they apply to addiction treatment.
Treatment programs equip their clients with tools that can be used over a lifetime to help the process of getting and staying sober. In 2017:
About 7% of Americans ages 12 and older had suffered from substance use disorders (SUD) in the past 12 months1
Approximately 3% of Americans ages 12 and over had drug use disorders1
Americans between 18 and 25 years old had the highest rate of drug use disorders, at 7%1
Another significant statistic that points to the need for effective substance abuse treatment is the overdose rates in the United States. In 2017:
There were more than 72,000 deaths from drug overdoses. The death rate tripled between 2002 and 20172
There are 88,000 alcohol-related deaths each year.1
The most effective treatment programs use a variety of therapies. Two of the most widely accepted therapies for substance abuse as well as mental health conditions, are EMDR and CBT. Let’s take a look at how each one can benefit clients.
EMDR and Addiction Treatment
Eye movement desensitization and reprocessing (EMDR) is a therapy used to treat a number of different conditions, including post-traumatic stress disorder (PTSD), phobias, anxiety, pain management, and addiction-related issues.
An EMDR therapist guides the client in safely recalling distressing past experiences in detail. The aim is to gain a new understanding of the events by exploring the emotions and physical sensations associated with the events. The thoughts and self-images generated by these memories are also explored. During this process, the client moves their eyes back and forth rhythmically. This allows the focus to be on the object rather than any inner monologue.
Addiction-focused EMDR aims to reprocess memories to reduce impulses to drink or take drugs.
CBT and Addiction Treatment
Cognitive-behavioral therapy (CBT) is built on the idea that faulty information processing that leads to distorted and dysfunctional thoughts can cause a person to have negative emotions and engage in harmful behaviors (such as substance abuse). A CBT therapist with identification and evaluation of negative thoughts. The therapist then supports the creation of more realistic and healthy thoughts that will lead to healthier behaviors.
Since substance use disorders (SUDs) are associated with using drugs or alcohol due to severe stress or mental health issues, CBT is a good fit for many people in addiction treatment.
Origins of a Dispute in the Medical Community
In the late 1980s, Dr. Francine Shapiro noticed that her eye movements helped to decrease negative thoughts and feelings from the past. 3 Dr. Shapiro decided to further explore this discovery by researching eye movements and their ability to desensitize people to traumatic memories.3 EMDR, as a mental health therapy, was created from her research.
Mental health providers are divided over EMDR.3 Since EMDR was introduced, it has generated considerable controversy, especially over the role of the eye movements as an active part of the treatment. There is also a debate over whether EMDR differs significantly from trauma-focused cognitive behavioral therapy or standard exposure therapy.
Further research by Dr. Shapiro has suggested that the dual attention component of EMDR (talking while moving the eyes) may be what makes it work, while eye movements alone might be less effective.3
Some people stated that EMDR was simply an overlap of trauma-focused CBT and other therapies.3 While many EMDR procedures can overlap with CBT, many mental health organizations consider these to be two different approaches because specific training programs are needed for each therapy.3 Also, EMDR, unlike trauma-focused CBT and exposure therapy, does not explore the event in detail, does not involve a direct challenging of beliefs surrounding the event, and does not involve exposure.3
EMDR vs. CBT for Specific Conditions
Post-traumatic stress disorder (PTSD) is a mental health disorder that can significantly impact life in negative ways. PTSD develops when an individual has experienced or witnessed an extremely traumatic, tragic, or horrifying event. People who have PTSD typically have recurring frightening thoughts and memories of their experience and feel emotionally numb around others, particularly loved ones.
In recent years, the definition of PTSD has been expanded to include people who have experienced less severe, but nonetheless disturbing events. Hurtful experiences with parents, peers, and children are a few examples of events that can cause PTSD in some people. Whether the PTSD-causing events are dramatic or not, unprocessed memories are the cause of PTSD symptoms.
EMDR for PTSD
EMDR helps people reprocess their upsetting trauma-related memories, feelings, and thoughts. In an EMDR session, the client pays attention to the back-and-forth movements of their eyes while thinking about the traumatizing event. This is done until the way those memories are experienced changes, and more information from the past is processed.
Once the trauma-related event is processed, the client can experience relief from PTSD symptoms.
CBT for PTSD
The CBT counselor provides guidance in logical thinking to create a new portrayal of a traumatic event. This will help lessen the emotional connection to the trauma by engaging the thinking part of the brain to reconnect to a new interpretation. People in CBT can still recall the event, but they have rewritten the story so that they are victorious and not victimized. Despite what happened in the past, they are now protected and safe, by choosing to find safety and protection within themselves. CBT participants become the creators of their stories. The CBT process helps rewire the brain, create new perceptions, and release trauma.
Self-esteem is about how people feel about themselves on the inside. People with healthy self-esteem are not dependent upon others to make them feel good about themselves; they know they are fine the way they are. People who struggle with low-self esteem may readily absorb negative messages from those around them or society. People with low self-esteem rarely feel “good enough.”
EMDR for Low Self-Esteem
It’s possible to develop negative feelings and core beliefs that cause low self-esteem due to past experiences. EMDR can help reprocess emotional memories used as evidence for core belief that they are not “good enough.” Processing these memories in an EMDR session makes it possible to re-evaluate the present meaning of those experiences, which can positively influence the person’s self-esteem.
CBT for Low Self-Esteem
CBT aims to teach clients practical skills to identify negative feelings and damaging thoughts and to replace these with more positive thoughts. CBT sessions also focus on facing and overcoming problems and challenges. As clients become more successful at these strategies, their self-esteem grows.
Panic Disorder and Anxiety
Research shows that both EMDR and CBT are effective for the treatment of panic disorder. EMDR treatment does reduce symptoms faster that are more long-lasting compared to CBT.4
EMDR for Anxiety
An advanced version of EMDR has been shown to reduce anxiety, and thus panic attacks. This is a breakthrough discovery since anxiety and anxiety-related disorders are the most common disorders found in the United States today. More than 40 million Americans are affected by anxiety disorders.4
Several studies showed that the eye movements performed during EMDR can lessen the emotional intensity of anxiety.4 The EMDR eye movements were performed while the client recalled a personal emotional episode that was connected to anxious thoughts. This recollection causes anxiety. As this anxiety is re-lived, the eye movements help reprocess the anxiety by reducing the intensity of persistent and intrusive images about potential future failures or disasters.
CBT for Anxiety
CBT is another effective treatment for anxiety disorders. In CBT sessions, clients are taught how to apply new strategies that focus on dealing with anxiety. Using self-observation and role-playing, clients develop alternative viewpoints that can reduce their anxiety levels. CBT for anxiety disorders is a practical approach that uses specific examples as starting points for changes.
Child trauma dramatically increases the chances that a person can develop PTSD, either soon after the trauma or much later, in adulthood. Psychological interventions, such as EMDR and CBT, can reduce the likelihood of developing PTSD.
EMDR for Child Trauma
To prevent or reduce the development of PTSD symptoms, EMDR has the client focus on the disturbing images, memories, emotions, and thoughts associated with the trauma. At the same time, the therapist guides them through rapid back-and-forth eye movements.
CBT for Child Trauma
To prevent or reduce the likelihood of PTSD symptoms after a traumatic event, CBT challenges the negative, distorted thought patterns connected to the trauma to help the client develop more adaptive thoughts and behaviors.
EMDR for Cancer Patients
EMDR therapy has been proven effective in treating the ongoing trauma and stress associated with cancer. It also has been shown to help the anxiety and depression that cancer patients can experience. Research shows that PTSD symptoms, anxiety, and depression were significantly reduced when a cancer diagnosis was discussed during EMDR treatment sessions.5
CBT for Cancer Patients
CBT’s psychotherapeutic approach that focuses on how people’s thinking affects the way they feel can be used to reduce the pain and negative emotions associated with various cancer conditions.
CBT for cancer patients can start with gathering important facts about cancer and what concerns the client has regarding their condition. One example is addressing the concerns a client may have over cancer treatments, like radiation or chemotherapy. The therapist would then explore the issue by asking the client to identify any negative thoughts and the impacts those thoughts could have during cancer treatment.
Then, the therapist guides the client through how the situation can be changed with thoughts that could make them feel better. This leads to the client exploring different perspectives that could change their feelings or thought processes to reduce negativity and increase positive thoughts and actions in everyday life and during cancer treatments.
Current Status of Disputes Over EMDR Effectiveness
According to Division 12 of the American Psychological Association, EMDR is still a controversial topic, because research shows that its effectiveness can be interpreted in various ways.6 Some research shows that people with PTSD who receive EMDR therapy show reduced symptoms compared to those who receive no treatment at all.
Other research that compares EMDR to exposure therapy (which is similar but without eye movements) has found no significant differences.6 These results may mean that, while EMDR is effective, the eye movements have no bearing on the results, and exposure therapy is just as effective without the unnecessary eye movements.6
More research needs to be done before definite conclusions about this controversy can be reached.
Can EMDR and CBT be Combined to Increase Effectiveness?
EMDR focuses on the thoughts, feelings, and images associated with the stored memories of an experience. Thus, EMDR sessions aim to reprocess the information related to past, present, or future experiences that are intensely emotional or negative. These experiences are often associated with mental health issues such as PTSD, anxiety, panic disorder, and depression. EMDR sessions tap into how a person feels and thinks about these events.
Negative thoughts based on past events can create irrational beliefs that the person holds onto persistently. These irrational beliefs can be quite harmful because they reinforce and impact the way the person thinks in other areas of life. EMDR can help the person gain insight and decrease the amount and level of these reactions in other life areas. EMDR helps the person by desensitizing them to images, feelings, and thoughts by stimulating both sides of the brain as they recall events while using eye movements.
Adding CBT to the mix can help integrate healthy ways of thinking into everyday life. The insights that EMDR provides can lay the foundation for casting off irrational beliefs of the past so they won’t be repeatedly played out in the present or future. CBT can help replace these negative thoughts and emotions with healthy ones in practical ways.
Getting Help for a Dual Diagnosis
While it is vital to get treatment for any type of mental health condition, such as SUDs, PTSD, anxiety, panic disorder, or low self-esteem, that greatly impacts a person’s life, it is also important to get the right type of help. Having a mental health issue and suffering from addiction is a dual diagnosis or co-occurring disorder.
EMDR and CBT are just two therapies in a wide array of treatments that can help address SUDs or mental health conditions. Other options include medications, alternative therapies, 12-step groups, and ruling out physical causes, to name just a few examples.
When substance misuse or abuse is involved, the best first step may be a medically supervised detoxification. This detox, which occurs under the supervision of medical professionals who slowly wean the body from illicit drugs or alcohol, helps to prevent or reduce any withdrawal symptoms that may occur. Replacement medications, nutrition, and hydration help keep the body comfortable and stable. A detox is not a standalone treatment. Once detox is completed, the next steps in recovery must be taken by entering an inpatient or outpatient treatment program.
For some people, substance abuse and mental illness become so severe that the best level of care is a residential facility. This is a good choice when people need additional support or have high risks for substance abuse relapse. It is also the best option when individuals are a danger to themselves or others. Residential treatment offers 24/7 inpatient care and a supportive, structured residence for clients in recovery.
Another option is intensive outpatient treatment. At this level of care, people attend therapy for several days each week, for several hours a day. After treatment is completed for the day, clients return home for the evening. These programs are also known as intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs). Despite their name, PHPs typically take place in clinics or treatment facilities and not in hospitals.
Also, standard outpatient treatment is an option. Outpatient programs (OPs) are similar to IOPs, but the amount of time a person attends each week is significantly less.
If you or someone you love lives with substance abuse or mental health conditions, there are many treatment options available. While any actions towards recovery are positive, it’s best to understand what research indicates about the effectiveness of different therapies and treatments, as well as any downsides or side effects.