Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic approach traditionally known for its success in treating trauma-related conditions, such as PTSD. Somatic approaches, like EMDR, offer a promising option for individuals experiencing intrusive thoughts and images stemming from a variety of sources, including anxiety, OCD, and trauma. That said, for people with Autism Spectrum Disorder (ASD) and other diverse neurological experiences EMDR may need thoughtful adjustments to meet their needs effectively due to possible heightened sensory sensitivities and unique cognitive styles. In what follows, we will explore how EMDR can be tailored to potentially better fit this population, emphasizing the unique considerations that make this therapy both a challenge and an opportunity for healing.
One of the key considerations when using EMDR with individuals with ASD is their frequent tendency to think visually. Research indicates that a significant proportion of people with ASD are "visual thinkers," meaning they process information predominantly through images rather than words. For these clients, intrusive thoughts may often manifest as vivid mental pictures that are particularly distressing. Even so, considering the orientation for visuals can be leveraged as a strength for the client. EMDR's bilateral stimulation, typically involving eye movements or tactile prompts, which may resonate with visual thinkers by engaging their natural cognitive strengths. By tapping into these visual processing capabilities, EMDR can help clients reprocess and reduce the intensity of these disturbing images, making them less intrusive over time.
Despite its potential, EMDR with neurodivergent clients comes with unique challenges. Sensory sensitivities, a hallmark of many neurodivergent experiences, may make some elements of EMDR, such as rapid eye movement or tapping, overwhelming or distracting. Clinicians who are well trained and experienced will know to collaborate closely with clients to identify the most comfortable and effective methods of bilateral stimulation. For instance, some clients may prefer slow-paced tapping over traditional eye movements, while others might benefit from auditory stimulation through headphones. Additionally, the structured nature of EMDR’s multi-phase protocol may need flexibility to accommodate communication differences or executive functioning challenges often experienced by neurodivergent individuals. Ultimately, one can maintain fidelity to the protocol while supporting the needs of neurodiverse clientele.
Another important consideration is the source of intrusive thoughts. For clients with ASD, these thoughts might not always stem from trauma but could be linked to anxiety, sensory overload, or repetitive thinking patterns characteristic of OCD. Given the propensity for clients with ASD to also have post-traumatic stress, it is possible that there are multiple layers of stimuli. EMDR’s ability to target and reprocess distressing memories or beliefs makes it a versatile tool for addressing a broad spectrum of intrusive experiences. For example, a client who struggles with recurring images of past social failures might benefit from EMDR’s capacity to reduce the emotional charge associated with those memories. Clinicians can work with clients to identify the “target” memories or thoughts most relevant to their distress and tailor treatment accordingly.
Incorporating EMDR into therapy for neurodiverse clients requires creativity and sensitivity, but the benefits can be profound. By leveraging the strengths of visual thinkers and adapting to sensory needs, EMDR can offer a path toward relief from intrusive thoughts and images. For potential clients and fellow clinicians, understanding these considerations can help unlock EMDR’s full potential for individuals with ASD and other neurodiverse experiences. With its growing evidence base and flexible application, EMDR stands as a powerful tool in the mental health landscape, offering hope and healing for those navigating the complexities of neurodivergence.
If you are local to Durham, NC – I welcome you to reach out to my email at ben@essentialcts.com or schedule time with me at https://www.therapyessential.com/client-portal.
Daring Greatly,
Ben Pruitt
LCSWA, MDiv
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Grandin, T. (2009). Thinking in pictures: My life with autism (Expanded ed.). Vintage Books.
Greenwald, R. (2013). EMDR within a phase model of trauma-informed treatment. New York: Routledge.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Williams, T. I., & Happé, F. (2010). What did I say? Versus what did I think? Perspectives on autistic thought processes. Journal of Autism and Developmental Disorders, 40(10), 1192-1196. https://doi.org/10.1007/s10803-010-0975-7
Wymbs, B. T., & Dawson, A. E. (2019). The role of sensory processing sensitivity in cognitive and emotional processes in autism. Autism Research, 12(6), 927-939. https://doi.org/10.1002/aur.2088
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