EMDR and Bipolar Disorder: What a Recent Trial Found

Bipolar disorder is treated primarily with medication, and for good reason. Mood stabilisers do the heavy lifting in preventing the episodes of depression and mania that define the condition. But medication does not address everything. Many people with bipolar disorder also carry histories of trauma, and those trauma-related symptoms tend to go untreated. Part of the reason is a long-standing clinical worry that stirring up difficult memories might destabilise someone's mood or trigger an episode. It is the same caution that kept trauma therapy away from people with psychosis for years. A multicentre randomised controlled trial led by Hogg and colleagues, published in the Spanish Journal of Psychiatry and Mental Health (2024), put it to the test. Seventy-seven people with bipolar disorder and current trauma-related symptoms were randomly assigned to 20 sessions of either EMDR adapted for bipolar disorder, or supportive therapy. The headline result was a miss. The trial's main aim was to reduce relapse into mood episodes, and on that measure there was no significant difference between the two groups. The secondary findings were more encouraging, and they lasted. At twelve-month follow-up, the EMDR group had significantly lower depressive symptoms, lower manic symptoms, and better day-to-day functioning than those who received supportive therapy. Those differences were still present six months after treatment finished. Just as important is what did not happen. Working directly on trauma did not increase relapses and did not increase dropout. The fear that trauma processing destabilises people with bipolar disorder was not borne out. The caveats are real. Only 50 of the 77 participants completed treatment, which is a substantial loss and limits how much weight the results can carry. This is also a single trial, and 20 sessions is a serious commitment of time. The measured conclusion is this. EMDR does not appear to prevent mood episodes, and nobody should expect it to replace medication. But where bipolar disorder sits alongside unresolved trauma, EMDR may reduce symptoms and improve functioning, and the evidence suggests it can be done safely. Regular readers will recognise the pattern. As with psychosis, and with borderline personality disorder, a diagnosis long treated as a reason to withhold trauma therapy is turning out not to be the barrier it was assumed to be. Source: Hogg, B., Radua, J., Gardoki-Souto, I., et al. (2024). EMDR therapy vs. supportive therapy as adjunctive treatment in trauma-exposed bipolar patients: A randomised controlled trial. Spanish Journal of Psychiatry and Mental Health, 17(4), 203 to 214.