Complex trauma can shape the way a person thinks, feels, and relates to the world. Many people are looking for answers about how therapy can help after years of distressing memories and emotional pain.
Understanding how complex PTSD differs from standard PTSD is an important first step. Exploring how EMDR therapy works provides a foundation for understanding how it is used in the treatment of trauma. At 449 Recovery, we use evidence-based approaches like EMDR as part of comprehensive trauma treatment that addresses both mental health and substance use disorders together.
What is Complex PTSD and How Does EMDR Help?
Complex PTSD (CPTSD) develops after long-term, repeated trauma that often happens over months or years. This includes ongoing abuse, neglect, or captivity. Standard PTSD usually follows a single traumatic event, like a car accident or natural disaster.
CPTSD describes the symptoms of PTSD (such as flashbacks, nightmares, and severe anxiety) plus additional symptoms. People with CPTSD can struggle with managing emotions, feel very negative about themselves, and have problems in relationships. They often experience ongoing difficulties with trust, self-worth, and emotional stability.
Key differences between PTSD and CPTSD include:
- Duration of trauma: PTSD results from a single event. CPTSD arises from repeated, long-term trauma
- Symptom profile: CPTSD includes problems with self-identity and relationships beyond PTSD symptoms.
- Treatment approach: PTSD treatment can be effective, but treating CPTSD often requires modifications to address layers of complex trauma.
EMDR (Eye Movement Desensitization and Reprocessing) is a therapy modality designed to help people process traumatic memories. The therapy uses guided eye movements or other bilateral stimulation while recalling distressing events. EMDR therapy for PTSD is based on the idea that trauma can get “stuck” in the brain, and the bilateral stimulation helps the brain reprocess these memories in a healthier way.
Why EMDR Works for Complex Trauma
Research shows that EMDR therapy can be effective in treating longstanding trauma histories. A 2024 case study in the Journal of Clinical Psychology found that EMDR therapy led to significant reductions in trauma symptoms, even when other mental health conditions were present.
Up to 77% of patients no longer met criteria for PTSD after EMDR treatment. The therapy works by using bilateral stimulation to help both sides of the brain process traumatic memories. This reduces the vividness and emotional intensity of these memories.
In real-world settings, people who receive EMDR therapy for PTSD often experience fewer flashbacks, nightmares, and feelings of being on high alert. Those with CPTSD may also report better emotional regulation, increased feelings of safety, and improved relationships.
What Happens During EMDR Sessions
EMDR sessions follow a structured process with specific steps. The therapy is guided by a trained therapist and includes safety measures throughout.
During the preparation phase, the therapist gathers detailed history and helps the person build coping skills. This may include learning grounding techniques and identifying positive memories to recall if distress comes up during sessions.
Next comes assessment and targeting. The therapist and client identify specific traumatic memories to focus on. They use two scales: SUDs (Subjective Units of Distress) measures how upsetting the memory feels on a scale of 0 to 10, and VOC (Validity of Cognition) measures how true a positive belief feels on a scale of 1 to 7.
The bilateral stimulation phase involves side-to-side movements like following a finger with the eyes, hand tapping, or listening to alternating sounds. The person thinks about the targeted memory while experiencing these movements.
During reprocessing and integration, the memory often feels different or less intense. New insights may develop, and beliefs about the memory or themselves may change. The session ends with steps to make sure the person feels stable before leaving.
How Long Does EMDR Take to Help Complex Trauma?
CPTSD often requires more sessions than single-incident PTSD because of the number and complexity of traumatic experiences involved. But there isn’t a single universal answer for how long it takes to heal from CPTSD with EMDR therapy.
Several factors affect treatment length, such as:
- Trauma severity: More severe trauma usually takes longer to process
- Number of traumatic memories: Multiple traumatic events require more sessions
- Current stability: Ongoing life stressors can slow therapy progress
- Therapeutic relationship: A trusting relationship with the therapist helps steady progress
Research shows different timeframes based on trauma type:
| Trauma Type | Typical EMDR Sessions | Timeframe |
|---|---|---|
| Single incident trauma | 6-12 sessions | 2-3 months |
| Complex trauma (CPTSD) | 20-40+ sessions | 6-18 months |
| Developmental trauma | 30-50+ sessions | 12-24+ months |
Signs of progress include less distress from traumatic memories, fewer flashbacks or nightmares, improved daily functioning, and feeling more stable in the present moment.
EMDR with “Parts” Work for Complex Trauma
Parts work is a therapy approach that helps people identify different aspects of themselves. These “parts” often develop as ways to cope with difficult experiences, especially during childhood trauma. For example, one part of a person might try to protect themselves by avoiding certain situations, while another part holds painful memories.
EMDR therapy with parts work can help for treating complex trauma because people with CPTSD may feel disconnected from themselves, or experience strong inner conflicts. Some parts of a person may be ready to process trauma, while others feel scared or want to avoid it.
The therapist helps the person in treatment identify parts that carry distressing memories or emotions. During EMDR therapy sessions, attention is given to each part’s feelings and experiences. If a part feels overwhelmed, the therapist can pause EMDR and use grounding techniques before continuing. This combination helps ensure that all parts of a person feel safe and supported throughout healing.
Addressing Concerns About Retraumatization
Some people worry that EMDR therapy for complex PTSD could bring back painful memories in an overwhelming way. Understanding the difference between productive processing and re-traumatization helps to clarify what happens in EMDR therapy.
Productive processing means remembering difficult events in a way that helps the brain make sense of them. EMDR therapy is structured and guided, so that old memories can be faced without reliving the full intensity of the trauma. Re-traumatization happens when someone feels as if the event is happening again, including the same intensity and loss of control.
Common fears about EMDR include:
- It forces reliving trauma: EMDR therapy uses controlled recall with safety measures, not forced re-experiencing
- It involves losing control: EMDR therapy includes steps to prevent overwhelming feelings and maintain stability
- It moves too fast: EMDR therapy for complex trauma often involves extended preparation for safety
Qualified EMDR therapists use several methods to prevent re-traumatization. They focus on preparation, helping people build coping skills before starting memory work. Therapists check for signs of distress and adjust the pace as needed. Containment techniques help to set aside distressing memories at session’s end, while grounding methods keep people connected to the present moment.
How EMDR Therapy Addresses Related Challenges
Many people with CPTSD experience other challenges like substance use disorders, depression disorder/, or relationship problems. These issues often develop as methods to cope with long-term trauma effects.
EMDR therapy doesn’t focus only on trauma memories. The therapy can target negative beliefs, fears, and patterns that contribute to substance use, depressive thoughts, or anxious feelings. By processing root memories and beliefs, people may notice changes in emotional responses and daily functioning.
449 Recovery uses a dual diagnosis approach, treating trauma and any co-occurring mental health simultaneously alongside substance use disorders. Clinicians assess for multiple challenges and use EMDR therapy as part of an integrated treatment plan. This approach helps to address connections between trauma, mental health, and substance use for more complete recovery.
Frequently Asked Questions About EMDR for Complex Trauma
EMDR therapy can address both original traumatic memories from childhood and the negative beliefs that developed as a result. This process helps reprocess early experiences and supports symptom reduction in people with CPTSD.
EMDR therapy is not considered appropriate for people experiencing acute psychosis, severe dissociative disorders, or those in crisis without first achieving stabilization. A qualified therapist can assess if EMDR is suitable for each individual case.
Online EMDR therapy can be as effective as in-person sessions for many people with CPTSD. Some people with severe dissociation may respond better to in-person treatment. Factors like technology comfort and safety in the virtual setting can also influence effectiveness.
449 Recovery provides person-centered, evidence-based trauma treatment that includes EMDR and dual diagnosis care. Our clinical team works with individuals who have both mental health and substance use concerns, integrating treatment for CPTSD and related challenges. For more information or to request a consultation, contact us today.
Dr. Sharif is a Licensed Marriage and Family Therapist who joined 449 Recovery in 2020 and oversees clinical operations as the Chief Clinical Officer. He earned his B.A. in Psychology and M.S. in Clinical Psychology from Vanguard University and completed his Doctor of Psychology from California School of Professional Psychology. Since 2011, Dr. Sharif has been dedicated to helping individuals, couples, and families heal from co-occurring disorders, including mental health, relational, and substance use challenges. He has led workshops on family dynamics, attachment injuries, spirituality in sobriety, and the impact of trauma on relationships.
