Exploring EMDR or Psychedelic Therapy First?

A representation of EMDR and psychedelic therapy, featuring a split screen with a calm, focused individual guided by a therapist on one side, and a serene, nature-inspired scene symbolising the psychedelic experience on the other. The image uses natural tones with vibrant colours to convey the therapeutic approaches.

Note: This is an opinion piece based on current evidence at the time of writing.
Disclosure: Writer has undertaken MAPS MDMA training and has not received training in EMDR. Writer has not treated using either modality. Views expressed herein are based on personal opinion and perceived cost-benefit at the time of writing. Seek medical advice before deciding if you intend to pursue either treatment modality.

Introduction

In recent years, both Eye Movement Desensitisation and Reprocessing (EMDR) and psychedelic-assisted therapy have gained significant attention as innovative approaches to treating trauma and other mental health conditions. As the mental health field continues to evolve, these methods are worth exploring, although it is important to acknowledge that we do not yet fully understand whether psychedelic therapy will be as effective or appropriate as some hope. Meanwhile, EMDR, despite being around for decades, still lacks sufficient systematic usage to firmly establish its place in mainstream therapy. For more information about PTSD, this article is a good starting point: What is PTSD? Definition, Symptoms, and Causes.

What is EMDR?

EMDR is a non-invasive therapeutic approach that uses bilateral stimulation—often through eye movements—to help individuals process and resolve traumatic memories. It's been endorsed by various mental health organisations and has a solid evidence base, particularly for treating post-traumatic stress disorder (PTSD). Despite its potential, EMDR is not universally adopted, and many clinicians are still unfamiliar with its application.

The Rise of Psychedelic Therapy

On the other hand, psychedelic therapy, which involves using substances like MDMA or psilocybin under professional supervision, is garnering significant interest, particularly for its potential in treating conditions resistant to conventional therapies. The altered states of consciousness induced by psychedelics may allow for deep emotional and psychological processing, akin to the reprocessing seen in EMDR sessions. Yet, this field is still in its infancy, with much of the research being preliminary and conducted under controlled, clinical conditions that may not be easily replicated in broader practice.

Similarities and Potential Integration

There are some intriguing similarities between EMDR and psychedelic therapy, particularly in their potential to alter brain activity and facilitate the reprocessing of traumatic memories. Both approaches appear to work by altering brain activity and connectivity patterns, which may facilitate memory reconsolidation and emotional processing. Some researchers have even suggested integrating these approaches—using EMDR to prepare clients for the intensity of a psychedelic experience or to help integrate insights afterward. However, these ideas remain speculative, with limited direct comparative research available to draw definitive conclusions.

Why EMDR Should Be Considered First

Given the current state of evidence, I would personally recommend exploring EMDR first before considering psychedelic therapy. EMDR has a more established safety profile, is non-pharmacological, and can be conducted in outpatient settings without the need for the intensive medical supervision required for psychedelic therapy. Moreover, it has been successfully used to treat a wide range of trauma-related conditions, often with fewer legal and logistical barriers.

Conclusion

In conclusion, while the potential for psychedelic therapy is exciting, it’s still an emerging field that requires much more research before it can be confidently recommended as a frontline treatment. EMDR, with its proven track record and growing body of evidence, remains a preferable first step for many individuals dealing with trauma. As we continue to explore these therapies, it is crucial to approach them with both optimism and caution, ensuring that we provide the best possible care based on the most robust evidence available.

References

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Krediet, E., Bostoen, T., Breeksema, J., van Schagen, A., Passie, T., & Vermetten, E. (2020). Reviewing the potential of psychedelics for the treatment of PTSD. International Journal of Neuropsychopharmacology, 23(6), 385-400.

Luoma, J. B., Chwyl, C., Bathje, G. J., Davis, A. K., & Lancelotta, R. (2020). A meta-analysis of placebo-controlled trials of psychedelic-assisted therapy. Journal of Psychoactive Drugs, 52(4), 289-299.

Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., Ot'alora G, M., Garas, W., Paleos, C., Gorman, I., Nicholas, C., Mithoefer, M., Carlin, S., Poulter, B., Mithoefer, A., Quevedo, S., Wells, G., Klaire, S. S., van der Kolk, B., Tzarfaty, K., ... Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 27(6), 1025-1033. https://doi.org/10.1038/s41591-021-01336-3

Pollan, M. (2018). How to change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence. Penguin.