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The Effects of EMDR Therapy on Pregnant Clients With Substance Use Disorders: A Narrative, Scoping Literature Review

American Association for the Advancement of Science
Journal of EMDR Practice & Research
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This narrative scoping literature review explores a significant clinical population, pregnant women with co-occurring substance misuse, through the lens of adaptive information processing and the potential for eye movement desensitization and reprocessing (EMDR) therapy intervention. A data search in PubMed, PsychINFO, Web of Knowledge, Science Direct, Cochran, and Scopus databases focusing on literature published within the last 10 years. Due to the distinctiveness of the issue, 10 research articles met the required inclusion criteria. The results confirm that EMDR can deliver effective outcomes for women with co-occurring substance use disorder during pregnancy. However, the rationale for using EMDR as a “sole-treatment” intervention appears insufficient. Instead, there is an argument supporting the utilization of integrative approaches. This review highlights the limited research available for this essential population and discusses the need for further study and investigation.
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Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
© 2023 EMDR International Association http://dx.doi.org/10.1891/EMDR-2022-0049
12
The Effects of EMDR Therapy on Pregnant Clients
With Substance Use Disorders: A Narrative, Scoping
Literature Review
Ingrid Tcheshmedjiev
Derek Farrell
University of Worcester, Worcester, United Kingdom
This narrative scoping literature review explores a signicant clinical population, pregnant women with
co-occurring substance misuse, through the lens of adaptive information processing and the potential
for eye movement desensitization and reprocessing (EMDR) therapy intervention. A data search was
performed in PubMed, PsychINFO, Web of Science, Science Direct, Cochran, and Scopus databases
focusing on literature published within the last 10 years. Due to the distinctiveness of the issue, 10
research articles met the required inclusion criteria. The results conrm that EMDR can deliver effective
outcomes for women with co-occurring substance use disorder during pregnancy. However, the rationale
for using EMDR as a “sole-treatment” intervention appears insufcient. Instead, there is an argument
supporting the utilization of integrative approaches. This review highlights the limited research available
for this essential population and discusses the need for further study and investigation.
Keywords: EMDR; pregnancy; substance use; PTSD
This narrative-scoping literature review inves-
tigates the existing knowledge and research
on eye movement desensitization and repro-
cessing (EMDR) therapy for pregnant women with
co-occurring substance use disorders. Given the dis-
tinctiveness of these two attributes, literature on the
topic was limited. Therefore, the rationale for this
review is to enhance awareness and critically consider
eective treatment interventions for this signicant
clinical population with high levels of complexity and
vulnerability.
The utilization of substance misuse by women
during their pregnancy is a signicant issue of con-
cern. Forray (2016) estimates that in the United
States, approximately 5.9% of pregnant women use
illicit drugs, and 8.5% consume alcohol, with over
half of this population engaging in polysubstance
misuse. Although many achieve abstinence during
pregnancy, relapse rates 6–12 months postpartum
are incredibly high. The corollary to this being the
adverse fetal health eects from substance misuse
exposure can be substantial. Alcohol use during preg-
nancy, in its most extreme form, can lead to fetal
alcohol syndrome (FAS). According to Popova et al.
(2017), 1 out of every 67 women who consume alco-
hol during pregnancy results in the birth of a new-
born child having FAS.
The co-occurrence of substance use disorder
(SUD) and posttraumatic stress disorder (PTSD)
is high, with samples varying between 11%–41%
(Ruglass et al., 2014; Sindicich et al., 2014; Smith &
Cottler, 2018). PTSD among pregnant women can
also be a result of previous birth trauma (Watson
et al., 2021). Clients with concurrent PTSD and
SUD show higher symptom severities and worse
treatment outcomes than those with either disor-
der alone. Rates of PTSD among pregnant women
range from 6% to 8%, and in lower socioeconomic
populations, it can be as much as 29% (Van Dam
etal., 2012). Pregnant women are also at higher risk
13Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
The Effects of EMDR Therapy on Pregnant Clients With Substance Use Disorders
of experiencing major depressive disorders (MDD)
and anxiety disorders than nonpregnant women
(Uguz et al., 2019; Zhou et al., 2020). When preg-
nant women have a prior history of mental health
problems, this potentially inuences prenatal stress
physiology, which can present in ospring with
issues such as diculties with stress regulation,
mental health problems, and cognitive development
concerns (Hartman et al., 2018; Lautarescu et al.,
2020). Risk factors also include preterm birth, lower
birth weight, mood disorders, postnatal depression
for the mother, and lower maternal-infant bonding
(Davis & Narayan, 2020). Therefore, the challenges
faced by this population are signicant, raising
the question of eective treatment interventions,
including EMDR therapy.
EMDR therapy is an empirically supported, com-
prehensive, client-oriented, eight-phase therapy
focused on memories of adverse life experiences (De
Jongh et al., 2019; Farrell et al., 2020). These adverse
memory networks contain images, thoughts and
belief systems, sounds, emotions, and physical sensa-
tions. A distinctive component of EMDR therapy is
its utilization of bilateral stimulation (BLS), a mem-
ory taxation device that involves eye movements and
auditory and tactile stimuli. The adaptive information
processing (AIP) theory provides an explanation and
a theoretical framework for the mechanisms involved
in EMDR (Shapiro, 2018). According to AIP theory,
an innate physiological system is designed to trans-
form disturbing input into an adaptive resolution
and healthy integration. Excess arousal may disrupt
this system, resulting in the information about trau-
matic experiences stored in a maladaptive, state-spe-
cic form. The procedural steps combined with BLS
in EMDR therapy are believed to restore balance and
resumption of information processing until reaching
an adaptive resolution for the client (Leeds, 2016).
Beyond the standard protocol in EMDR therapy treat-
ment, several protocol variations have been devel-
oped, including some directly targeting both addiction
and perinatal issues.
Methods
A comprehensive search was undertaken using
PubMed, PsychINFO, Web of Science, Science Direct,
Cochran, and Scopus databases to review salient
research. The search dates were between May 1, 2012
and May 1, 2022. In the search, the following terms
were used: “EMDR” AND “substance use” (including
addiction) AND “pregnancy” (including perinatal)
using Boolean connectors.
Additional exclusion criteria were publications
over 10 years old, postpartum studies only, clinical
protocols, addictive behaviors only, and substance
misuse only. Following this criterion, 10 studies met
the requirements (Figure 1).
Narrative scoping, which uses textual rather than
statistical approaches, was used to identify salient
themes from the studies for this paper. Scoping
reviews help map the characteristics of the existing
literature to identify salient gaps and research needs.
Thematic analysis was chosen as the method of
data analysis for this review. According to Braun &
Clark (2014), thematic analysis is a distinct method for
identifying, analyzing, and reporting repeated patterns
within the literature in constructing themes. Two dis-
tinct themes were identied concerning EMDR ther-
apy: pregnancy and substance misuse (Table 1).
Findings
Theme 1: EMDR and Pregnancy
In a study by Sandstrøm et al. (2008), EMDR was used
to treat women in Sweden who had developed PTSD
following traumatic birth experiences. Although the
initial aim was to treat pregnant women, the study
included four participants, of which only one was
pregnant. The traumatic event scale and interviews
were used to measure symptoms and changes, and fol-
low-up measures were done 4 months (or after birth)
and 1–3 years after therapy. Participants received four
to six sessions of EMDR therapy, lasting 50–90 min-
utes. After treatment, the participants no longer ful-
lled the criteria for PTSD. These results remained
at follow-up 1 and 3 years after therapy for three of
the four participants. The participant who had been
pregnant during treatment reported satisfaction with
the treatment and her second birth experience as
being dierent in a positive way. Recruitment of and
follow-through by the participants was a challenge in
this study. The authors acknowledge the limitations
of this study as it had a small sample size and no con-
trol group. They conclude by advocating the impor-
tance of diagnosing PTSD after a traumatic birth, and
although EMDR is a possible treatment, caution is
needed. The best time for intervention may be some
months after childbirth but before the subsequent
pregnancy.
Stramrood et al. (2011) investigated the same topic
in their study, where three pregnant women received
EMDR therapy to treat their PTSD after traumatic
deliveries. Studies have found that women with these
experiences usually do not recover spontaneously, and
subsequent pregnancy may act as a trigger for PTSD
14 Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
Tcheshmedjiev and Farrell
symptoms. Consequences may be stress inuencing
the fetal environment, fear of upcoming birth, and
more caesarean sections. The participants received
between four and six EMDR therapy sessions. Their
experiences of previous deliveries included medical
traumas, pain, and experiences of not being supported
by hospital sta. After treatment with EMDR ther-
apy, all women had fewer symptoms of PTSD. They
reported feeling calmer and more condent about the
upcoming birth, all wishing to attempt vaginal birth
rather than an elective caesarean section. Although
one of the women had complications with her birth,
all women reported the second birth as a positive
experience. The study is limited by a small sample
and a lack of structured questionnaires and psycho-
metrics. Stramrood et al. (2011) were also consistent
with Sandstrøm et al. (2008), highlighting the need for
treatment during pregnancy rather than afterward.
However, they point out that women with PTSD fol-
lowing childbirth may not mention their symptoms
until their subsequent pregnancy, and the time left
for treatment is limited until the upcoming birth.
Stramrood et al. (2011) concluded that EMDR therapy
appeared to be an eective treatment intervention.
A randomized controlled study (RCT) conducted
by Zolghadr et al. (2019) investigated the eect of
EMDR therapy on childbirth anxiety among 30
women with previous stillbirths. The women were
now pregnant again with a normal pregnancy. They
were randomly assigned into two groups. EMDR ther-
apy for the intervention group was performed with a
90-minute session when participants were admitted
to the hospital for birth. The control group received
only routine care. The Van Den Bergh Pregnancy-
Related Anxiety Questionnaire was administered
before treatment and 48 hours after birth. A statisti-
cally signicant reduction in the mean anxiety in the
EMDR intervention group compared to the control
group was reported, as well as a reduction in the
scores of posttests compared with a pretest for the
EMDR group (p < .01). All participants had uncom-
plicated deliveries. The authors conclude that one
session of EMDR therapy was a practical and valu-
able method for reducing anxiety among pregnant
women and a strategy to encourage normal child-
birth. Despite these results’ positivity, caution needs
to be exercised as the treatment delity involved in
this study is lacking.
Figure 1. PRISMA 2020 ow diagram for narrative, scoping review (Page et al., 2021).
Identication of studies via databases
Records identied from* databases:
Addiction (n = 69)
Pregnancy (n = 20)
Total (n = 89)
Records removed before screening:
Duplicate records removed
(n = 0)
Articles assessed using inclusion
criteria total: (n = 89)
Articles rejected re exclusion
criteria total: (n = 79)
Studies included in review.
(n = 10)
IdenticationScreeningIncluded
15Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
The Effects of EMDR Therapy on Pregnant Clients With Substance Use Disorders
Cortizo’s (2020) article discusses the integration
of EMDR with family therapy treatment. Although
not a scientic study, her article describes suggestions
for implementing EMDR treatment for pregnant
women, illustrated by a case example. The Calming
Womb Family Therapy Model proposes that EMDR
is recommended to treat most prenatal mothers with
few exceptions from the beginning of pregnancy. It is
essential to provide multidisciplinary and multiphased
treatment to support the expectant mother and her
unborn child. Cortizo (2020) points out that high
and prolonged concentrations of the stress hormone
cortisol have harmful eects on the developing baby
and suggest EMDR as well as other trauma-informed
treatments are benecial, especially for women with
preexisting histories of trauma. Stabilization tech-
niques are suggested to prevent common maternal
fears that trauma processing will negatively aect
the fetus. Stabilization and resourcing may also be
benecial in preparation for birthing, even in cases
where the mother is unwilling or not ready to pro-
ceed with further trauma treatment. A careful pace,
tailored treatment, and shorter reprocessing time are
suggested. In describing the steps of the intervention,
Cortizo (2020) uses a case example. The woman, in
this case, worked on reprocessing traumatic mem-
ories of childhood sexual abuse and was surprised
at the positive eects as she felt a sense of release.
Coming closer to her due date, she wanted to focus
on birth fears and birthing resources. Multiple targets
were reprocessed, with treatment continuing after
birth as well. Cortizo (2020) refers to some common
myths about EMDR therapy, for example, that it is
best to wait until the second trimester. She will likely
be in her second trimester by the time reprocessing
starts due to preparation phases. Another myth is
that the fetus may be aected by high cortisol levels
during reprocessing. However, the goal is to reduce
TABLE 1. Research Articles Used With the Narrative, Scoping Review
Authors
Year of
publication Title Type of study
1. Baas et al. 2020 The eects of PTSD treatment during pregnancy:
Systematic review and case study
Systematic review and case
study
2. Carletto et al. 2018 EMDR as add-on treatment for psychiatric and traumatic
symptoms in patients with substance use disorder
Pilot study (n = 40)
3. Cortizo 2020 Prenatal and perinatal EMDR therapy: Early family
intervention
Discussion paper and single
case design
4. Kullack &
Laugharne
2016 Standard EMDR protocol for alcohol and substance
dependence comorbid with posttraumatic stress
disorders: Four cases with 12-month follow-up
Case series study (n = 4)
5. Markus et al. 2019 Addiction focused eye movement desensitization
and reprocessing therapy as an adjunct to regular
outpatient treatment for alcohol use disorders: Results
from a randomized clinical trial
Literature review
6. Perez-Dandieu
& Tapia
2014 Treating trauma in addiction with EMDR: A pilot study Pilot study (n = 12)
7. Sandstrøm et al. 2008 A pilot study of eye movement desensitisation and
reprocessing treatment (EMDR) for post-traumatic
stress after childbirth
Pilot study (n = 4)
8. Stramrood et al. 2012 The patient observer: Eye movement desensitization and
reprocessing for the treatment of posttraumatic stress
following childbirth
Case series (n = 3)
9. Wise & Marich 2016 The perceived eects of standard and addiction specic
EMDR therapy protocols
A qualitative
phenomenological design
(n = 9)
10. Zolghadar 2019 The eect of EMDR on childbirth anxiety of women
with previous stillbirth
RCT study (n = 30)
16 Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
Tcheshmedjiev and Farrell
stress over sessions, and resourcing and self-care are
part of the treatment. Determining how much dis-
comfort the mother tolerates is evaluated in active
collaboration. A third myth is the need to ask for
Obstetrics/Gynecology or the midwife’s permission
to proceed with EMDR prenatal therapy. However,
they often lacked information about how EMDR
works, highlighting why this aspect is an essential psy-
choeducative task to be performed by EMDR thera-
pists. Cortizo (2020) concludes that pre-/perinatal
EMDR therapy must be readily available.
Baas et al. (2020) conducted a systematic review of
the treatment of PTSD during pregnancy, including
a single case study of a woman treated with EMDR.
The authors state that although several trauma-
focused psychotherapeutic interventions for treating
PTSD are available, unfortunately, pregnant women
are often excluded or underrepresented in clinical
research. As a result, there is a lack of evidence about
the eectiveness and potential risks of treating PTSD
during pregnancy. Patients and professionals may
be reluctant to start therapy, fearing arousal during
trauma processing may harm the unborn child and
may wish to postpone treatment until after birth.
However, no indications have been found supporting
that therapy to reduce PTSD symptoms would be
harmful. The authors highlight that there is no sup-
port for a course of action in which the continued
presence of PTSD is preferable to the low chance of
short-term physiological arousal during treatment for
symptoms of PTSD, referring to studies showing cor-
tisol levels up to 10 times higher for pregnant women
with PTSD related to childhood abuse, compared to
nontraumatized women. The case example in their
review is a pregnant woman who had given birth three
times before. Her rst birth had been complicated,
and she had received one session of EMDR therapy to
work on this experience during her second pregnancy.
The EMDR intervention was successful, and the birth
was uncomplicated. However, in her third pregnancy,
intrauterine fetal death occurred unexpectedly.
Postpartum, she had received grief therapy. Her
screening for this study showed she scored above the
cuto for PTSD and fear of childbirth (FoC), and was
diagnosed with obsessive-compulsive disorder (OCD).
EMDR therapy included working on her worst future
fears with two sessions of the ash forward technique,
and the third session aimed at installing a positive
vision in which she constructed her future childbirth.
She reported experiencing less tension. After nish-
ing therapy, she scored under the cuto value for
FoC, and the diagnoses of OCD and PTSD were in
complete remission. She had an uncomplicated birth
and expressed satisfaction with her experience. Her
PTSD and FoC symptoms showed a further decrease
at follow-up. The authors conclude that treatment of
PTSD during pregnancy is most likely safe and that it
seems essential to intervene so that the fetus can grow
in a safer environment.
Theme 2: EMDR and Substance Use
Perez-Dandieu and Tapia (2014) investigated the stan-
dard EMDR therapy protocol’s eects on patients
with comorbid PTSD and substance use disorders.
Twelve women with alcohol and/or drug depen-
dency in a clinic were randomly assigned to treat-
ment-as-usual (TAU) or TAU plus eight sessions of
EMDR (TAU+EMDR). Measures of PTSD symp-
toms, addiction, depression, anxiety, self-esteem, and
alexithymia were used. The study aimed to target the
traumatic memories, not the substance use. However,
outcomes were measured in both areas to investigate
whether reprocessing traumatic memories would
lead to changes in addiction. The TAU+EMDR group
showed a signicant reduction in PTSD symptoms.
EMDR treatment was also associated with a signi-
cant decrease in depressive symptoms, while patients
receiving TAU only showed no improvement in this
area. The TAU+EMDR group also showed signicant
changes in self-esteem and alexithymia posttreatment
and a decrease in anxiety.
However, EMDR treatment did not signicantly
decrease alcohol and drug use. The authors suggest
that reprocessing traumatic memories may be insuf-
cient to reduce substance use and propose attend-
ing to addiction memories. The study results suggest
that PTSD symptoms can be successfully treated with
standard EMDR in substance use patients, potentially
enhancing overall treatment outcomes.
The standard EMDR protocol was also utilized in
the case series by Kullack and Laugharne (2016). Four
participants with PTSD attending a clinic in Australia
were recruited for the study. Before treatment, three
patients met the criteria for alcohol dependence, and
one met the criterion for substance dependence. The
participants reported a history of increased alco-
hol/substance use after their traumatic experiences.
EMDR therapy focused solely on their trauma history,
not the addiction, and no other treatment intervention
for addiction was oered. The participants’ histories
included traumatic experiences from work, adult-
hood, and childhood. The number of sessions ranged
from four to nine. MINI Plus, PCL-C, and client state-
ments were used as measurements. At the 12-month
follow-up, three out of four clients did not meet the
17Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
The Effects of EMDR Therapy on Pregnant Clients With Substance Use Disorders
diagnostic criteria for current alcohol or substance
dependence. One client still met the criteria for alco-
hol dependence but reported a reduction in craving
and consumption since treatment. Participants’ mean
PTSD symptoms had been 55.25 on initial assessment
with PCL-C (scores higher than 44 indicating PTSD)
and were reduced to 21.25 at the 12-month follow-up.
The authors discuss the positive outcomes of their
study concerning the self-medication hypothesis, as
a reduction in PTSD symptoms and stress through
EMDR therapy may decrease the need to self-regulate
by using alcohol or drugs. Although the study had a
small sample size and no control group, Kullack and
Laugharne conclude that their study suggests that
treatment of PTSD with the standard EMDR proto-
col can positively aect substance use symptoms.
In their qualitative, phenomenological study, Wise
and Marich (2016) investigated the subjective experi-
ence of EMDR therapy with nine participants in the
United States who had co-occurring PTSD and addic-
tive disorders. The research participant’s experience
with both the EMDR standard protocol and addic-
tion-specic protocols was investigated using struc-
tured interviews. All participants reported positive
outcomes from the combined EMDR approaches,
with the mean length of time in the treatment being
3.6 years. The study identied four themes and two
subthemes, with participants recognizing their addic-
tive disorder related to their trauma:
Participants identied remission of addictive and
trauma-related symptoms.
Treatment was perceived to be eective whether
the trauma was treated rst or the addiction.
Integrated treatment (EMDR+other) was opti-
mal for ongoing recovery from addiction and
traumatic disorders.
A safe relationship with the therapist is essential
for successful therapy. Participants in the study
reported that working on traumatic memories
did not increase their desire to use substances or
practice addictive behavior.
All participants in the study received treatment
in private practice settings, resulting in a lack of
diversity in the sample.
The authors encouraged the conduct of similar stud-
ies in public practice settings where most clients do
not have access to the number of sessions aorded by
the participants in their study.
Carletto et al. (2018) enrolled 40 patients with SUD
in their quasi-experimental study to assess the ecacy
of a combined trauma-focused (TF) and addiction-fo-
cused (AF) intervention. Twenty patients received
TAU, whereas the other 20 received TAU plus 24 ses-
sions of EMDR. Participants were recruited from two
settings in Italy: an outpatient service and a residential
facility. Participants chose if they wanted assignment
of the TAU or the TAU+EMDR group. EMDR treat-
ment included both the standard protocol and addic-
tion-focused EMDR protocols. Several psychometric
measures were used at baseline and after the end of
treatment, as well as urine drug testing. There were
dierences between the two groups at baseline, as the
TAU+EMDR group had higher PTSD and anxiety
symptoms. The results showed a signicant reduc-
tion of PTSD symptoms in both groups, but in the
TAU+EMDR group, the eects were signicantly
greater than in the TAU group. The TAU+EMDR
group also reduced dissociative symptoms, anxiety,
and overall psychopathology. The addition of EMDR
resulted in posttreatment normal levels from base-
line levels above the clinical cuto. Urine drug test-
ing showed no dierences between the groups, and
aspects related to craving and abstinence were not
explicitly investigated. The dierences in the groups
at baseline due to the study being a nonrandomized
one could impact the conclusiveness of the results.
The authors suggest that the dierence in results may
be impacted by the fact that higher reductions are
observed when the starting levels are higher.
Furthermore, EMDR may be more useful in
clients with more traumatic experiences due to the
high implications of such experiences in treating SUD
clients. The authors conclude that EMDR could be
an ecient and well-accepted add-on treatment for
clients with SUD, showing promising results for com-
bining trauma-focused and addiction-focused EMDR
protocols.
An RCT examining addiction-focused EMDR
(AF-EMDR) was conducted by Markus et al. (2019).
Patients with alcohol-use disorder (AUD) were
recruited at six outpatient facilities in the Netherlands
and randomly assigned to either TAU or TAU +
seven weekly 90-minute sessions of AF-EMDR. The
AF-EMDR therapy used a manual called the palette
of EMDR interventions in addiction. TAU involved
community reinforcement approach (CRA) treat-
ment. N=109 participants were enrolled, and 76 par-
ticipants had completed the treatment. Assessments
were made at baseline, after therapy (or 8 weeks),
and at 1- and 6-month follow-ups. Measurements
assessed drinking behavior, craving, and quality of
life. Inclusion criteria were a primary diagnosis of
alcohol dependence or abuse, whereas clients with
current use of alcohol or substances and a current
PTSD diagnosis were excluded.
18 Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
Tcheshmedjiev and Farrell
The results showed no add-on eect of AF-EMDR
regarding drinking behavior. More TAU-only partici-
pants showed improvement in alcohol consumption,
whereas more participants in the TAU+AF-EMDR
group experienced fewer cravings. These ndings
were unexpected, as the CRA treatment (TAU) in other
studies has proved eective compared to other alco-
hol treatments, suggesting results may reect a lack
of eect of AF-EMDR therapy and TAU. Theauthors
hypothesize that timing may have impacted the
results, as the enrollment period was broadened due
to diculties in recruiting. Consequently, this could
have resulted in most of the progress achieved before
the commencement of the study.
Additionally, it may have resulted in a selection
of more treatment-resistant clients being included
since they had not yet reached their treatment goals.
Another aspect is that levels of distress and craving
targeted in AF-EMDR were low, to begin with, and
low emotional arousal may have led to the inter-
vention being less eective. As ndings suggest, the
intensity of emotional arousal is a prerequisite for the
degrading eects of eye movements on negative auto-
biographical memories. The AF-EMDR study manual
diers from the standard procedure in which new tar-
gets are to be selected and treated in every session for
time eciency, leading to complete desensitization
not always being possible. This component may have
inuenced the results. The authors suggest focusing
on the conditioning response as well. Antecedents
and consequences of alcohol use may produce better
results than focusing on trigger situations alone.
Discussion
Synthesis from a review of these 10 papers suggests the
eects of EMDR therapy in reducing PTSD symptoms
with pregnant clients resorting to substance misuse.
Treating traumatic experiences with EMDR therapy
appears to have good outcomes for pregnant clients
and those with substance use disorders. However, the
eectiveness of EMDR therapy in treating substance
misuse on its own is less conclusive. More research is
needed to oer the best EMDR therapy interventions
to these clients. As Wise and Marich (2016) suggest,
most clients prefer an integrative treatment approach
that addresses trauma and addiction elements.
In the academic literature, there appears to be
more research on EMDR and the postpartum period
than during pregnancy. Research tends to focus on
previous traumatic birth experiences, even with preg-
nant clients. From an AIP perspective, the origins of
current trauma symptomatology are often historical,
yet evidence suggests that this is frequently ignored.
From a comprehensive EMDR therapy perspective,
a thorough assessment and treatment of the entire
trauma landscape should be considered. Additionally,
the literature suggests that EMDR would be benecial
in treating traumatic experiences in pregnant women
regardless of the origin of the trauma. Furthermore,
the literature suggests the benets of using EMDR
therapy with PTSD and Complex PTSD and that vul-
nerability is not a contraindication.
In pursuing this issue further, the issue of safety
is an essential consideration for pregnant women.
Sandstrøm et al. (2008) and Stramrood et al. (2011)
concur with Shapiro’s (2018) initial assertion to exer-
cise some caution with this client group. As Shapiro
(2018, p. 89) writes, “The potential eects of aroused
emotion in pregnant women should also be consid-
ered. While there have been no reports of serious
physical side eects, it is always better to use caution.”
This raises an interesting ethical question—is it better
to do something or nothing? Each intervention needs
to be considered on its merits. What the literature
seems to suggest is the potential for “proof of con-
cept” in that there appears to be a clinical benet in
using EMDR therapy with pregnant women with, or
without a history of substance misuse, whether past
or current. Although the optimal time for treatment
interventions may be before pregnancy and after a
period of abstinence from drugs, this may not be a
viable clinical option on certain occasions. Shapiro
(2018) highlights that EMDR is a client- centered
exible approach and that both clinician and client
should participate in collectively determining the
goals of therapy. This tailoring may be essential when
working with more complex and vulnerable client
groups.
What this exploration highlights is the paucity of
available research in this area. To address decits in the
academic literature, current RCT studies in operation
include the OptiMUM study; a multicenter trial carried
out in the Netherlands (Baas et al., 2017) with pregnant
women with a pathological FoC. Additionally, a fur-
ther study explores the eects of EMDR on PTSD in
inpatient clients with substance use problems (Schäfer
et al., 2017). Another study by Valiente-Gomez et al.
(2019) with outpatient clients explores the utiliza-
tion of EMDR with substance misuse and comorbid
trauma. In Norway, a study plans to investigate the
eects and implementation of EMDR as trauma treat-
ment in outpatients with trauma symptoms and sub-
stance use disorders (Oslo Universitetssykehus, 2020).
These upcoming RCT studies will provide more con-
temporary insights into this much-needed area of
19Journal of EMDR Practice and Research, Volume 17, Number 1, 2023
The Effects of EMDR Therapy on Pregnant Clients With Substance Use Disorders
investigation. However, within the EMDR commu-
nity, there appears to be no studies planned to explore
the utilization of EMDR therapy specically for preg-
nant mothers engaged in substance misuse.
Conclusion
This narrative-scoping literature review has limita-
tions in highlighting the paucity of research available
in this area. In addition, a mixture of research meth-
odologies was used in the 10 studies reviewed, which
dramatically limits true cross-comparisons between
the studies. As with many popular movements within
psychotherapy, EMDR needs to continue in its push to
pursue and extend current knowledge and application
to maximize the operationalization and implementa-
tion of this treatment approach safely and eectively.
As Davis and Narayan (2020) point out, the preg-
nancy period is a window of opportunity to identify
risks to both the fetus and the mother. It also represents
a possibility to nurture better mental health and pro-
mote recovery. Pregnant women are more in contact
with the medical system, giving opportunities for inter-
ventions. The upcoming birth may motivate change,
and evidence points to increased plasticity in the mater-
nal and the fetal brain during the prenatal period.
Although the population of pregnant substance
users is limited and specic, research on this complex
group is a substantial investment. It will not only have
implications for the individual client but may make a
dierence for future generations.
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Disclosure. The authors have no relevant nancial interest
or aliations with any commercial interests related to the
subjects discussed within this article.
Funding. The authors received no specic grant or nancial
support for the research, authorship, and/or publication of
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Derek Farrell, University of Worcester, Worcester. Email:
d.farrell@worc.ac.uk
Chapter
This chapter provides a comprehensive overview of eye movement desensitization and reprocessing (EMDR) therapy in the context of childhood mental health issues. It explores the origins, principles, and therapeutic mechanisms of eye movement desensitization and reprocessing therapy. One of the keys focuses of this chapter has been the adaptation of this therapy for children. Finally, this chapter emphasizes the importance of training and supervision for therapists working with EMDR therapy among children, as well as the need for further research and development in this field. This chapter concluded that eye movement desensitization and reprocessing therapy has emerged as a widely accepted and effective treatment approach for addressing mental health problems among children. By incorporating this therapy into their practice, mental health professionals can provide evidence-based interventions to help children overcome mental health challenges and promote their overall well-being.
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