Rebecca Saunders (00:03.864)
Hello and welcome to the EMDR Doctor podcast. This is a podcast for clients where I share and explore information about all things EMDR.
My name is Dr Caroline Lloyd. I'm a mental health GP and an EMDR practitioner. And my goal is to demystify EMDR or eye movement desensitization and reprocessing to help you on your EMDR journey. EMDR is a powerful therapy which helps to reduce the distress from difficult memories. And my goal is to make it accessible to everyone. I hope you enjoy this episode. Hello and welcome back to the EMDR Doctor podcast. I'd like to start
by acknowledging the traditional owners of the land. I'm recording this podcast on Wurundjeri land and I'd like to pay my respects to the elders past, present and emerging. And I am back in Australia, back on my local turf and much as Thailand is really beautiful it's always nice to be home. And one of the things I did notice about Thailand when I first went there is every corner of every street has a shop
devoted to the sale of drugs. So it's a little bit unusual to come from Australia where there's nothing obvious to where it's really in your face all the time. So today I am talking about drugs and medications with EMDR. I'm going to cover a bit of a range from prescriptions to psychedelics. So we'll touch briefly on a couple of areas. And I'm going to start with the obvious alcohol with a very simple piece of advice.
Please don't drink prior to your EMDR session.
Rebecca Saunders (01:47.17)
And this is kind of a no brainer, but I thought I'd start with an easy one and just take that off the table. Most therapists have a pretty clear alcohol policy. If you turn up to a session with a couple of drinks on board, then your therapist will likely tell you to come back another day without the alcohol on board. So the reason for this is that we just can't do therapy while intoxicated. It clouds judgment. It's disinhibiting. It's also depressant. So the results are not likely to be good.
all had experiences with trying to talk sense into someone intoxicated and it's not a pretty sight and it's just not appropriate for therapy. So it's a very simple hard no for alcohol and the same goes for recreational drugs. But what about other medications? EMDR and antidepressants are absolutely fine. There doesn't seem to be any bad effects on EMDR processing from being on antidepressants at the time.
which is really interesting because many people do report this feeling of being a bit cut off from their emotions with some antidepressants. But in the long term, it does not seem to have any sort of detrimental effect on the effects of EMDR. So when we are processing a memory, we do need the memory to be activated. For example, we need the emotions associated with the memory to be available and to be present.
And this can sound a little bit mean. we, as clinicians, we...
actually want the client to be able to feel the upset to do with that memory. But what we know is that if we are able to feel it, then we can process that feeling and then it need not return. So I my clients that the tears that they cry in an EMDR session, they do not need to cry again. And there's a little meme that goes around with regards to EMDR and feelings that you need to feel it to heal it.
Rebecca Saunders (03:50.852)
So whilst it sounds like a bit of a cliche, it is true. Your therapist will help you to be able to feel it in a just enough kind of a way. There are lots of techniques that we can use to kind of titrate the feeling so that it's tolerable and you're not being overwhelmed by the feelings. And also we are doing effective work at the same time.
So the reason I'm telling you this is that there are some medications that reduce feelings. So the antipsychotics and the benzodiazepines and the opiate analgesics, we need to be a little bit sensible with what we take before a session. So what I'm about to say refers to all of these three classes of meds in the same way.
So whilst we don't want you to skip a dose or be say four hours overtue for a regular dose of diazepam for example, because that would cause a withdrawal type of reaction and it would cause a lot more unnecessary anxiety and distress. We don't want people to be sedated and zoned out. And sedation means that we can't access the distress of the memory. And if we activate the memory without the distress,
then we cannot then decouple the memory from the distress. So when the benzodiazepine or opiate wears off, the distress will return. So the EMDR won't have been so effective. It is much better and in the long term easier to access that distress once in the EMDR session, resolve it and settle it down and then it doesn't need to return.
It does take courage and I want to recognise that some memories do take a great deal of courage to face up to without the aid of medication. Occasionally, in really severe cases of PTSD, the memory is too hot to touch without the use of medication and it's just intolerable to work with. So if that person is on benzodiazepines, then we may suggest a small dose prior to having a processing session.
Rebecca Saunders (06:01.056)
And then we progress to working on the memory again later with a smaller dose without the drugs on board. So we use the drugs to be able to facilitate a little bit of processing around that horrible memory. And then once we've taken a little bit of the heat out of it, we might be able then to approach it without any medications on board.
and do the more thorough job of processing it with all the emotions that come with that. So that's a long process and we would have to process the memory, the same memory a few times in order to reduce the distress down to zero. But we work with what's in front of us and some work is better than none.
And if we're moving forward, then that's better than just waiting for a future day where we may or may not be able to process without the same issue. So to summarize that in general, it is better to do EMDR without taking benzodiazepines.
like Valium, for example, or opiates, for example, like codeine or like oxycodone, oxycontin, sort of endone, that sort of thing, or antipsychotics like quetiapine. They're just some examples of those classes of medications. So it's better to process without them on board. Sometimes we need them on board.
And that's fine. It will take a little bit longer, but we just work with what we have in front of us. Sometimes we can work around the schedules of the doses so we can schedule a good time to do the EMDR. For example, if someone's on a nine o 'clock, nine a dose of, say, for example, Valium, then we can perhaps suggest to move the dose a little bit later.
Rebecca Saunders (07:53.492)
over a few days to say 10am and then we can organise for the EMDR session to be done at 9pm so the medication can be taken after the EMDR session is finished. And this gives the best of both worlds so we can process without the diazepam on board and we can still stick to the medication regime without interfering with the schedule.
So I probably should say here that this is not individual advice that you need to talk to your therapist about this. And if you're taking these sort of medications, you might want to talk to your prescribing doctor and most doctors will be happy to have a discussion about the best way to schedule your medications so that you can get the best out of your therapy. So I've covered alcohol, antidepressants, analgesics, benzodiazepines.
And I'll just touch briefly on THC and CBD oil. So I did a little bit of a literature search because I didn't want to give you the wrong information, but I can't find any information on EMDR with people who are taking THC and CBD oil. So I'll just let you know my personal experience. I have worked with people who have been on stable doses of these and they've processed just fine. And these memories
The memories that we've processed have been resolved and we haven't needed to work further on them down the track. So that's just my personal experience of working with those medications. So please do chat to your therapist and your doctor. If you are thinking about going off them, please don't take my advice about that. You need to do that with the advice of your doctor. But they do seem in my experience to be fine to do EMDR with.
So I'm just going to touch on medications for ADHD now. Ritalin, Vivants, Dexamphetamines, those sort of medications. In my opinion, and this is just my opinion, it is better to take your regular stable dose of ADHD medications before you have an EMDR processing session. People seem to think more clearly and just be a little bit more settled.
Rebecca Saunders (10:10.85)
does reduce anxiety a little bit, but I don't think that that interferes with EMDR processing. And I definitely wouldn't be withholding medications for ADHD before doing EMDR processing. So once again, I couldn't find any information about that in the literature, but if you're on something regularly, probably better to continue on taking it. If you are uncertain about any of this, please do just chat to your
EMDR therapist about how to manage your medications. But quite often there's a lot of misinformation that's going around about medications with EMDR. know, people come in and say, I've been told I have to go off all my medications before I have EMDR. Well, no, that is absolutely just not right. I don't want you to do that. I especially don't want you to stop medications suddenly and without any advice. That would be a bad move for most people.
So I just want to reassure you that we can work around things, we can work with things, we can work through things, we can find a solution that works for you. So the last topic I'll talk about today is psychedelics and EMDR. Now I'm just going to touch on this really, really briefly because there's actually, there's a lot of talk about it in the popular press and so on.
So psychedelics being psilocybin, MDMA and ketamine. And there are lots of trials going on as we speak with psychedelics.
and utilizing psychedelics and EMDR concurrently. And they seem quite exciting, but we just don't have the data on them right now. So it's an area that I think, you know, I personally will be keeping a very open mind about because they potentially have the possibility of doing some very fast healing for some really difficult memories. But we just don't know just yet. So I might.
Rebecca Saunders (12:15.358)
see if I can find somebody to interview at a later date and have a little bit of a chat in more depth with somebody who has some of that emerging information. I think one guiding principle there would be
If you're interested in doing that work, you will need to work with someone who has been properly trained and who has experience in it. So that that would be the one piece of advice I would give about using psychedelics with EMDR. It's a little bit of a frontier kind of area. We don't know that much about it. It is a little bit exciting. It's a bit intriguing and there will probably very soon be some good information available.
So I look forward to bringing you a bit more information about that as time goes on.
So I might wrap up there. Before I wrap up, I will just apologize for the noises that you may have heard in the background today. So I am minding a little puppy and she has been quite hard to settle down. So I've tried to talk in between her in between her vocalizations, but sometimes it hasn't been entirely possible. So there are a few little squeaks and groans in the background.
So I hope that hasn't been too bothersome. All right, until next week. I hope you have a great week. Take care. Bye for now.
