Eye Movement Desensitization and Reprocessing as a Treatment for Substance Use Disorders

What Works and Why? Eye Movement Desensitization and Reprocessing as a Potential Treatment for Substance Use Disorders

Substance Use Disorders (SUD) are often comorbid with psychological trauma, however, the complex interaction between the two is not yet fully understood. Most addiction-specialized professionals do not engage in exploring past traumatic experiences of the patients due to personal, professional, and educational barriers. Therefore, psychological trauma remains highly undetected and its contribution to the development and maintenance of SUD is neglected. This compromises the therapeutic results of most interventions, with relapse rates in SUD still remaining impressively high. EMDR is one of the most effective interventions for Post-Traumatic Stress Disorder (PTSD), and has been applied to other disorders that are often comorbid with trauma, such as psychosis and depression, with promising results. Nevertheless, its application in SUD is still limited. Taken altogether, there is a need to clarify the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) therapy in SUD, as well as the mechanisms of action that mediate its potential therapeutic effects.

The aim of this study is to 1) determine the efficacy of EMDR therapy in patients with SUD comorbid with psychological trauma, as well as whether changes in these clinical variables correspond to changes in salivary cortisol levels- a robust marker of the Hypothalamic-Pituitary-Adrenal (HPA) axis; 2) investigate the mechanisms of action of EMDR therapy, paying special attention to the key role that the cerebellum might play in mediating its therapeutic effects.

Study Overview

• Status: Completed
• Conditions: Substance Use Disorders
• Intervention / Treatment: Behavioral: EMDR; Behavioral: TAU

• Study Type: Interventional
• Enrollment (Actual): 64
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Barcelona
    • Barcelona, Barcelona, Spain, 08036
      • Hospital Clinic De Barcelona

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• A primary DSM-5 diagnosis of moderate to severe SUD, assessed by a clinical interview.
• No active drug consumption.
• Having experienced one or more traumatic events, assessed by the Life Event Checklist DSM-5 (LEC-5) and the Childhood Trauma Questionnaire (CTQ).
• Current posttraumatic symptoms, evaluated with the Impact Event Scale-Revised (IES-R).
• Aged from 18 to 65 years old.
• Sign an informed consent to participate in the study.
• Capable of speaking and comprehending Catalan or Spanish.

Exclusion Criteria:

• Having received a trauma-focused therapy within the last 5 years.
• Severe dissociative symptoms according to the Dissociative Experience Scale (DES).
• Presence of acute suicidal ideation.
• Acute episode of a comorbid psychiatric disorder.
• Severe cognitive impairments.
• Medical illness that compromises the HPA-axis.
• Long-term exposure to corticoids.
• Claustrophobia.
• Subjects with pacemakers.
• Presence of metallic objects within the body.
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Eye Movement Desensitization and Reprocessing therapy; 8 to 10 individual 60-minutes sessions over 2 months.	Behavioral: EMDR; The first session consists of recording the patient's history. In the second session the therapist evaluates the presence of coping mechanisms of the patient and, if necessary, suggests extra coping techniques. The following sessions are devoted to the reprocessing process. During these sessions, a target memory is identified and processed using EMDR. After a total of 8-10 sessions, it is expected that the patient will have achieved physiological reconciliation, relieved distress, and the ability to reformulate negative beliefs.; Behavioral: TAU; treatment as usual for substance use disorders
Active Comparator: Treatment as usual; Same periodicity as the experimental group and at the same time range.	Behavioral: TAU; treatment as usual for substance use disorders

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
time to relapse	Relapse is defined as a return to the addictive behavior, different from a punctual consumption, which is considered as a lapse. This will bee measured by the Time Line Follow Back self-report (TLFB)	2 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
changes in functional connectivity	measured by resting-state fMRI	2 months
percentage of conditioned eyeblink responses (CR)	measured by the Eyeblink Conditioning System	2 months
CR latency, CR onset, and CR amplitude.	measured by the Eyeblink Conditioning System	2 months
Hair and salivary cortisol levels	Comparison of the Area Under the Curve pre and post treatment	2 months
Craving	Self-report measurement	2 months 3 months and 5 months
Total amount of substance consumed during the previous month	measured by the TLFB	2 months, 3 months and 5 months
Changes in depressive symptomatology	measured by Beck's Depression Inventory (BDI)	2 months, 3 months and 5 months
Changes in anxious symptomatology	measured by The State-Trait Anxiety Inventory (STAI)	2 months, 3 months and 5 months
Changes in posttraumatic symptomatology	measured by Clinician-Administered PTSD Scale (CAPS)	2 months, 3 months and 5 months
Changes in global functioning	measured by Functioning Assessment Short Test (FAST)	2 months, 3 months and 5 months

Collaborators and Investigators

• Sponsor: Hospital Clinic of Barcelona

Publications and helpful links

General Publications

• Sanchez DF, Blithikioti C, Piazza F, Nuno L, Blanco L, Rodriguez-Rey A, Munoz-Moreno E, Balcells-Olivero M, Miquel L. Eye movement desensitisation and reprocessing as a potential treatment for substance use disorders: study protocol. Eur J Psychotraumatol. 2025 Dec;16(1):2531595. doi: 10.1080/20008066.2025.2531595. Epub 2025 Aug 12.

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2022
• Primary Completion (Actual): June 1, 2025
• Study Completion (Actual): June 1, 2025

Study Registration Dates

• First Submitted: June 2, 2022
• First Submitted That Met QC Criteria: August 3, 2022
• First Posted (Actual): August 4, 2022

Study Record Updates

• Last Update Posted (Estimated): September 16, 2025
• Last Update Submitted That Met QC Criteria: September 10, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders; Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities; Desensitization, Psychologic; Eye Movement Desensitization Reprocessing
• Other Study ID Numbers: PI20/00506

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No