CBT combined with EMDR for resistant refractory obsessive-compulsive disorder report of three cases

Objective: Cognitive-Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP) is the most studied and empirically validated form of treatment for Obsessive-Compulsive Disorder (OCD). However, this therapeutic modality can be extremely demanding and stressful for many patients, especially those with severe OCD symptoms and those who are particularly resistant to the usual therapies. Therefore, alternative forms of intervention - such as the Eye Movement Desensitization and Reprocessing (EMDR) - are of great therapeutic interest. The present study describes a cases series reporting how the processing of traumatic memories and obsessive contents can facilitate the treatment of symptoms in resistant cases with OCD. Method: Three cases have been described and analyzed in detail. Attention has been focused particularly on how to enable patients to regulate their emotions, and on the treatment of sensations and cognitions associated with traumatic memories. A hybrid intervention, composed of EMDR and CBT therapies, was administered. This involved three distinct ways to use EMDR through and combined it with CBT in the psychotherapeutic treatment. During the first phase of treatment with the first subject, EMDR was applied to contents related to the patient's thoughts (obsessions of contamination), the residential context. The second patient (with obsessions of aggression) was treated with CBT and EMDR first administered in a day-hospital facility and subsequently as an outpatient treatment; with the third patient, EMDR was also administered as an outpatient, during a relapse prevention plan. Results: All three patients showed a clinically significant reduction in symptoms. Conclusions: These are only three case reports so we can draw only anectodal conclusions EMDR could be a useful method to implement current treatments when combined with CBT, also for OCD resistant patients; however, future randomized controlled trials would be needed to validate these findings.