Working with Serious Mental Illness in EMDR: A Trauma-Informed Approach

Eye Movement Desensitization and Reprocessing (EMDR) therapy is widely recognized as an effective treatment for trauma-related conditions, particularly Post-Traumatic Stress Disorder (PTSD). Its application with individuals experiencing Serious Mental Illness (SMI)—such as schizophrenia, bipolar disorder, and severe major depression—requires careful consideration, adaptation, and a trauma-informed approach.

Understanding Serious Mental Illness and Trauma

Serious Mental Illness encompasses psychiatric disorders that significantly interfere with daily functioning. Research indicates a high prevalence of trauma histories among individuals with SMI, suggesting that trauma may play a role in the onset or exacerbation of these conditions. Addressing underlying trauma can be crucial in the holistic treatment of SMI.

  • Read et al. (2005) conducted a comprehensive literature review highlighting the strong association between childhood trauma and the development of psychosis and schizophrenia.
  • Mueser et al. (1998) found that 98% of individuals with severe mental illness reported exposure to at least one traumatic event, with 43% meeting criteria for PTSD, though only 2% had this diagnosis documented in their charts. 

EMDR Therapy: An Overview

EMDR is a structured psychotherapy that facilitates the processing of traumatic memories through bilateral stimulation, such as guided eye movements. It aims to reduce the distress associated with traumatic memories and foster adaptive coping mechanisms. EMDR is typically delivered in weekly sessions over several weeks, with the exact duration tailored to the individual’s needs.

Applying EMDR with Individuals Experiencing SMI

When considering EMDR for clients with SMI, clinicians should adopt a phased and trauma-informed approach:

  • Stabilization First: Prioritize establishing safety and stability before initiating trauma processing. This may involve developing coping skills and ensuring the client’s environment supports therapeutic work.
  • Adapted Protocols: Modify EMDR protocols to accommodate cognitive and perceptual challenges. This could include shorter sessions, simplified language, and the use of grounding techniques.
  • Collaborative Care: Work in conjunction with psychiatrists, case managers, and other professionals to provide integrated care, especially when managing medication and monitoring for symptom changes.
  • Ongoing Assessment: Continuously evaluate the client’s readiness for trauma processing and adjust the treatment plan accordingly.

Evidence Supporting EMDR for SMI

Emerging research supports the use of EMDR in treating trauma-related symptoms in individuals with SMI. For instance:

  • de Bont et al. (2016) conducted a randomized controlled trial demonstrating that EMDR significantly reduced PTSD symptoms in patients with psychotic disorders.
  • Marlow et al. (2023) found that EMDR, delivered within a trauma-informed framework, was associated with reduced distress and improved affect regulation in clients with co-occurring trauma and psychosis.

These findings suggest that, with appropriate modifications, EMDR can be a valuable component of treatment for this population.

Conclusion

Integrating EMDR therapy into the treatment of individuals with Serious Mental Illness requires a nuanced, trauma-informed approach. By prioritizing stabilization, adapting protocols, and collaborating across disciplines, clinicians can effectively address the complex needs of this population and support their journey toward healing.

References:

  1. Read, J., van Os, J., Morrison, A.P., & Ross, C.A. (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112(5), 330-350.
    https://pubmed.ncbi.nlm.nih.gov/16223421/
  2. Mueser, K.T., Rosenberg, S.D., Goodman, L.A., & Trumbetta, S.L. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66(3), 493-499.
    https://pubmed.ncbi.nlm.nih.gov/9642887/
  3. American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults.
    https://www.apa.org/ptsd-guideline
  4. de Bont, P.A.J.M., van den Berg, D.P.G., van der Vleugel, B.M., de Roos, C., de Jongh, A., van der Gaag, M., & van Minnen, A. (2016). Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders. Psychological Medicine, 46(11), 2411-2421.
     https://pubmed.ncbi.nlm.nih.gov/27297048/
  5. Marlow, S., et al. (2023). A pragmatic randomized controlled exploratory trial of the effectiveness of Eye Movement Desensitization and Reprocessing therapy for psychotic disorder. Journal of Psychiatric Research, 169, 257-263.
    https://www.sciencedirect.com/science/article/pii/S0022395623005332

Natalia Monge

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Dr. Amanda Martin, LMFT-S, LPC, BCN

Amanda Martin holds a PhD in Family Therapy and is a Licensed Professional Counselor, Licensed Marriage and Family Therapist Supervisor, and EMDRIA Approved Consultant. With over 14 years of experience, she specializes in trauma therapy for individuals and families in residential and outpatient settings. Amanda also provides supervision for EMDR certification, EMDR consultants-in-training, and LMFT-Associates. Her mission is to help people find a healthy, joyful, and fulfilling path in life. Her warm, supportive, and interactive counseling style incorporates Symbolic Experiential Therapy, Trauma-Focused Cognitive Behavioral Therapy, EMDR, HeartMath, Animal-Assisted Therapy, Neurofeedback, and Collaborative Problem Solving.

Dr. Amber Quaranta-Leech, LPC-S

Amber holds a PhD in Counselor Education and Supervision from Regent University. She is a Licensed Professional Counselor in both Texas and Oklahoma and holds Supervisor credential for Texas. Amber is an EMDRIA consultant and trainer. She has over a decade of experience in the trauma field in work with uniformed services, domestic violence, childhood trauma and abuse, and recent mass trauma events. Amber provides consultation for EMDRIA certification, for consultants-in-training, and supervision for LPC-Associates. Amber continues to research the benefits of EMDR therapy with a variety of populations. Her goal is to help build strong clinicians who are well versed in trauma interventions to better support their clients. Amber sees a limited number of clients with a focus on trauma work, she is also a Certified Career Counselor and Certified through EAGALA to provide equine-assisted therapy. 

Dr. Jose Carbajal, LCSW

Dr. Jose Carbajal, a U.S. Army veteran, earned his bachelor’s and master’s degrees in social work and a master’s in theological studies from Baylor University, and a Ph.D. in Social Work from the University of Texas at Arlington. With over 15 years of clinical experience and extensive teaching experience, Jose specializes in trauma, sexual abuse recovery, domestic violence, and substance abuse. His research focuses on trauma interventions, neuroscience, and faith. He is EMDR Certified, an Approved Consultant, and an EMDRIA Approved Trainer, with numerous publications and professional presentations to his name.

Dr. Amber Quaranta-Leech, LPC-S

Amber holds a PhD in Counselor Education and Supervision from Regent University. She is a Licensed Professional Counselor in both Texas and Oklahoma and holds Supervisor credential for Texas. Amber is an EMDRIA consultant and trainer. She has over a decade of experience in the trauma field in work with uniformed services, domestic violence, childhood trauma and abuse, and recent mass trauma events. Amber provides consultation for EMDRIA certification, for consultants-in-training, and supervision for LPC-Associates. Amber continues to research the benefits of EMDR therapy with a variety of populations. Her goal is to help build strong clinicians who are well versed in trauma interventions to better support their clients. Amber sees a limited number of clients with a focus on trauma work, she is also a Certified Career Counselor and Certified through EAGALA to provide equine-assisted therapy. 

Dr. Jose Carbajal, LCSW

Dr. Jose Carbajal, a U.S. Army veteran, earned his bachelor’s and master’s degrees in social work and a master’s in theological studies from Baylor University, and a Ph.D. in Social Work from the University of Texas at Arlington. With over 15 years of clinical experience and extensive teaching experience, Jose specializes in trauma, sexual abuse recovery, domestic violence, and substance abuse. His research focuses on trauma interventions, neuroscience, and faith. He is EMDR Certified, an Approved Consultant, and an EMDRIA Approved Trainer, with numerous publications and professional presentations to his name.

Dr. Amanda Martin, LMFT-S, LPC, BCN

Amanda Martin holds a PhD in Family Therapy and is a Licensed Professional Counselor, Licensed Marriage and Family Therapist Supervisor, and EMDRIA Approved Consultant. With over 14 years of experience, she specializes in trauma therapy for individuals and families in residential and outpatient settings. Amanda also provides supervision for EMDR certification, EMDR consultants-in-training, and LMFT-Associates. Her mission is to help people find a healthy, joyful, and fulfilling path in life. Her warm, supportive, and interactive counseling style incorporates Symbolic Experiential Therapy, Trauma-Focused Cognitive Behavioral Therapy, EMDR, HeartMath, Animal-Assisted Therapy, Neurofeedback, and Collaborative Problem Solving.