EMDR Therapy and Anxiety

Tell us a little bit about you, your experience becoming an EMDR therapist, and how you became interested in the topic of anxiety?

In the early 1980s, I attended an open meeting of a TERRAP group (which stands for Territorial Apprehension) as part of a school research project that was examining the nature of anxiety and its treatment. At this particular meeting, group members were sharing how debilitating it is to suffer from agoraphobia, as well as how they got their lives back after going to therapy. It was heart-wrenching to hear the stories of how paralyzing anxiety can be, and I was equally impressed by how therapy gave people their lives back. It was at that point I decided I wanted to become a psychologist.

As EMDR therapy was being introduced to the world, I was working as a master’s level cognitive behavioral therapist (CBT) who solely treated clients suffering from anxiety disorders. While I saw many clients overcome their struggle with anxiety, I noticed that the success of my clients seemed to be directly correlated with a great deal of risk-taking and commitment to carrying out homework assignments. Some of my other clients struggled with this approach to therapy, and I wanted to help them as well. These clients were always on my mind as I worked to learn other approaches during my doctoral program.

EMDR therapy was recommended to me personally after a series of events in my life triggered an onslaught of recurring nightmares. EMDR therapy was life-changing, and I experienced growth and healing to an extent I never dreamed was possible. At that point, I became eager to go to a training. I knew EMDR would help my clients with a history of trauma, but I had yet to understand the Adaptive Information Processing (AIP) model. An understanding of the AIP is vital in appreciating and applying EMDR therapy for other presenting issues, such as anxiety. Once I grasped the AIP model, I had a greater capacity to help clients with anxiety who did not respond well to CBT alone.

Can EMDR therapy help with anxiety? What successes have you experienced when using EMDR therapy with anxiety?

Anxiety is an umbrella term used to describe a vast continuum of somatic, cognitive, and emotional experiences. Anxiety may be as mild as the experience of butterflies in the stomach to the opposite extreme of full-blown panic accompanied by the fear of dying or another catastrophe. The experience of anxiety can be tied to past events, current situations, or future scenarios, which dovetails nicely with the three-pronged approach in EMDR therapy.

EMDR therapy is an effective approach to treating anxiety, and there are a few ways to go about tailoring the approach of treatment to meet different client’s needs. For people who experience panic attacks as life-threatening, the panic attacks themselves may be the EMDR target. Often, targeting the first, worst, and most recent experience of panic attacks as described by Shapiro (2018) works effectively for eliminating the distress associated with these experiences as well as the fear of having more panic attacks. However, for people facing an imminent future event with overwhelming dread, the Reverse Protocol (Adler-Tapia) may be more appropriate. For other clients, targeting present triggers, such as body sensations, is the most effective approach. For these clients, I have found that integrating some CBT approaches can be helpful.

Are there cautionary measures you would like to mention regarding the use of EMDR therapy with anxiety?

The symptoms of anxiety range from uncomfortable to terrifying, so it makes sense that the goal for a lot of people is to get rid of the anxiety once and for all. However, since anxiety is the body’s system warning us that danger is present, it is neither possible nor practical to eradicate anxiety from our lives completely. Instead, EMDR therapists should encourage their clients to put on their “detective hats” to figure out the source of the anxiety. In my TEDx talk, I said that anxiety is a messenger trying to point us to something important, something we need to address. If we try to get rid of anxiety symptoms without uncovering what those symptoms are trying to tell the client, our therapy will not be as effective. Doing so is like pulling off the top of a weed rather than digging out the root (Fee, 2018).

What multicultural considerations might EMDR therapists need to keep in mind regarding using EMDR therapy and clients coping with anxiety?

EMDR therapists need to remember that while all people experience anxiety, it is not necessarily described and expressed in the same way across different cultures. Western cultures are the most likely to use psychological terms such as “anxiety” and “panic” to describe their experience. In contrast, people from other cultures might use different words or metaphors or describe their experience just by discussing their physical symptoms. Expressing anxiety through physical symptoms is common for people from Latino, Chinese, many African cultures, and Middle Eastern cultures.

Some of these differences in expression depend on what is acceptable in a particular culture. In cultures where the stigma regarding mental health issues is high, it may be more socially acceptable to express anxiety via physical complaints such as fatigue, dizziness, headaches, sleep disturbances, or gastrointestinal problems. This can also be true for people from collective cultures with an emphasis on living in harmony with others, family honor, and societal expectations. These values may be both the source of one’s anxiety and the reason that the anxiety is expressed more indirectly.

There’s a lot we can learn as EMDR therapists about specific cultural expressions of anxiety. While most of us learned about panic disorder, generalized anxiety disorder, and agoraphobia in graduate school, we might not have learned about “ataque de nervios,” Tajjin-Kyofu-Sho (TKS), “abdominal wind syndrome,” or “Koro” which all describe specific cultural expressions or understandings of anxiety.

As we strive to understand our particular clients’ experiences and expressions of anxiety, we should consider how we might tailor and adapt EMDR therapy for them. During phase two resourcing, for example, it may be appropriate to help clients access culturally specific resources such as traditional practices, community or community elder support, meditation, prayer, or rituals. There may be culturally relevant metaphors and language that could be incorporated into our resourcing approach. I have found that the “light” from the Light Stream technique can mean different things to clients from various cultures. We must integrate our client’s cultural perspectives and beliefs as much as we can into our approach to EMDR therapy.

Do you have any favorite free EMDR-related resource that you would suggest to EMDR therapists working with this population?

Diaphragmatic breathing is an essential skill that EMDR therapists should introduce their clients to in phase 2. There are lots of free videos and handouts on the subject; however, I do like this video published by Dr. Jamie Marich.

The Winter 2024 issue of the Go With That Magazine™️ is entirely devoted to EMDR and Anxiety. While the magazine is a paid benefit of EMDRIA membership, EMDRIA makes one article from each issue free in the Focal Point Blog. The article I wrote on anxiety for this issue can be accessed here.

EMDR therapists getting started working with clients with panic disorder and agoraphobia might appreciate this free chapter of Eye Movement Desensitization and Reprocessing EMDR Therapy Scripted Protocols and Summary Sheets.

What would you like people outside the EMDR community to know about EMDR therapy and anxiety? Are there myths you’d like to bust about using EMDR therapy with anxiety?

I would love for people outside of the EMDR community to know that EMDR therapy is not just for PTSD and severe trauma but can be used to address panic attacks, phobias, and OCD. EMDR therapists might work directly with symptoms, past unresolved events, or upcoming future events, depending on what makes the most sense for your particular situation.

Jennifer L. Fee, Psy.D. is a clinical psychologist and EMDR Consultant™ who has helped people with anxiety disorders for over 30 years. In addition to private practice, Dr. Fee spent a significant portion of her career in graduate education and directed a master’s level program. She currently works at the EMDR International Association as the professional practice content specialist. Dr. Fee is passionate about fighting the stigma that surrounds mental health issues and advocating for EMDR therapy via writing and speaking. She has given a TEDx talk and made two appearances on Monique Coleman’s Discovery channel series, “Gimme MO,” discussing sexual assault, mental health, and EMDR therapy.

References

Adler-Tapia, R. (2019, October 7). A Proposal for an EMDR Reverse Protocol. www.drrobbie.org/post/a-proposal-for-an-emdr-reverse-protocol

Fee, J. (2018, October). Anxiety is the messenger [Video]. TEDxCSULB. YouTube. www.youtube.com/watch?v=JoDe1Blxb8s

Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing: Basic principles, protocols and procedures (3rd ed.). New York, NY: Guilford Press.

Back to Focal Point Blog Homepage

Additional Resources

If you are a therapist interested in the EMDR training:

If you are EMDR trained:

If you are an EMDRIA Member:

EMDR Therapy and Anxiety