Why are my anxiety and depression symptoms worse after an EMDR session?

5 Tips from an EMDR Therapist in Westchester, NY to help manage dysregulation between EMDR Therapy reprocessing sessions

I want to start by saying that the decision to pursue EMDR therapy is a brave one. Trauma work can be painful, and scary- but we don’t do the work for no reason. The intention is for things to get better and more manageable as we move forward.

Trauma work is like shaking a bottle of soda. All of the carbonation inside that bottle has become aggravated. EMDR has been designed to slowly let out that gas inside of the bottle to ensure that it’s contents doesn’t just explode everywhere.

This is why Phase 2 is so important. It’s the insurance that we have the tools to make sure that we control the speed in which we open the bottle cap. During the Preparation Phase of treatment, we design containment strategies, self-regulation tools, co-regulating resources, and healthy ways to process emotions (such as journaling, exercise, mindfulness practices, etc.).

Although we have these resources, it can still feel uncomfortable. Using the analogy from before, the soda might not be exploding everywhere- but we still feel the pressure of that carbonation stuck in the bottle. In other words, although we are using our coping tools we may still feel intense discomfort that is challenging to sit with and experience.

The reality of trauma work is that it is likely that it may temporarily feel worse before it feels better. But don’t worry- this is only temporary!

I write this to share 5 tips on how to manage this reality of the tough work you are embarking on…

1. (Actually) Practice your tools outside of session

I often hear clients describing triggers, images, cognitions, emotions, and sensations (TICES) they’ve noticed between sessions.

When I ask: “So what helped you manage those?”

The common response is some variation of: "I just waited for it to pass".

Yes, you may be able to wait for these dysregulating experiences to pass--but why sit and suffer? The resources you and your therapist designed are to help during these moments- not just in session, but also outside of sessions.

When I ask: “Looking back on those moments you described, what resources do we have that you think may have helped in that moment?”

I’ll hear clients respond by saying things like:

“I should have put that memory in my container”

“If I had gone to my calm-place it would have helped”

or, “I should have called a friend when I noticed my thoughts were taking me to a dark place.”

You know your tools--you don’t have to be with your therapist to use them!

2. Pre-plan before reprocessing sessions

It is expected that when we begin reprocessing traumatic memories that it can cause a temporary increase in symptoms. The bilateral stimulation used when reprocessing can naturally cause people to feel more tired than usual. You may notice that your window-of-tolerance is smaller after your reprocessing sessions.

With that said, it can be helpful to pre-plan anticipated needs before your session. This might look like:

• Not jumping back into work (or other responsibilities) right after your session.

• Having your journal or TICES log close by to have an outlet to express yourself.

• Choosing to order take-out rather than having the responsibility of cooking that day.

• Making sure you have ample rest before your session (and after your session)

3. Reflect on: Positive Insights / Emotions/ Sensations/ Memories that came up in sessions

Phase 4 of EMDR (reprocessing) is not only meant to process the “yuck that’s stuck”. During your reprocessing sessions there typically is a combination of both maladaptive and adaptive information that is processed.

Clients often report that they have been ruminating on the disturbing material between sessions. Yes, you may think of some of the “negative” stuff that came up--but you’re also allowed to reflect on the adaptive information that came up as well (and should!).

When closing a reprocessing session it’s important to identify the material that you want to contain between sessions, but also to identify the materials that you want to take with you and hold on to.

Examples of this may look like (but are in no way limited to):

• A thought such as: “That experience was scary, but I am safe now” or “I am a good person”, or "It wasn't my fault".

• A protective or insightful 'part' of yourself that showed up.

• Positive imagery or memories.

• A sensation such as reduced tension in body.

4. Ask your support network for extra support

As I said before, this is HARD WORK. You are allowed to need extra support- and you’re allowed to ask your support team for that!

This might look like:

• Letting your friends/family know that you may be more tired or preoccupied than usual.

• Some people may choose not to drive after a reprocessing session- ask someone to give you a ride to and from your appointment.

• Checking in with someone before or after your appointment- maybe not to discuss the content of what came up, but just to have a sense of connection to others who care about you. Co-regulation is a precursor to self-regulation.

5. Discuss scheduling longer reprocessing sessions with your therapist

The benefits of scheduling longer reprocessing sessions can include:

• Working through Phase 4 “quicker”. The less time we have in the between sessions the more likely we are to reprocess memories quicker. This is because the channels of association are open longer- allowing for more adaptive information to be processed.

• Additional time at the end of sessions to practice grounding or containment tools. If you find that reprocessing sessions tend to be dysregulating for you, you may want to plan for additional time at the end of your session to help return to a sense of presence.

• With more time to process you are likely to notice more of those “positive” or “adaptive” insights coming up in session to help balance out the distressing material that is being digested.

With these tips to help you in your EMDR therapy treatment plan, you can find what helps the most for you while working through your trauma healing. Always ask your therapist questions and share anything that comes up. They are there to be your guide!

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Annabella Lipson is a Licensed Mental Health Counselor at Peaceful Living Mental Health Counseling in Scarsdale, NY.

She enjoys working with young adults & adults who are dealing with grief, constant sadness, anxiety, PTSD and other heavy emotions that make it difficult to enjoy the present moment.

Annabella has an innate ability to make her clients feel comforted and cared for as they confront their grief and loss.

Schedule a phone consultation today!