Maxim LipatovPracticing psychologist
Published:
Updated:
EMDR (Eye Movement Desensitization and Reprocessing) is a powerful and effective psychotherapy method, recognized by the WHO and included in clinical guidelines worldwide for treating PTSD and other conditions. However, like any therapeutic tool, it has its contraindications and limitations.
Client safety is the top priority. In this article, we will examine in detail when EMDR should not be used, when special caution is required, and when it should only be used in conjunction with a medical professional.
Absolute Contraindications
In these cases, the use of EMDR is strictly prohibited, as it may cause serious harm.
| Contraindication | Why It Matters |
|---|---|
| Psychotic disorders (schizophrenia, schizoaffective disorder, delusions, hallucinations in the active phase) | The method requires a stable connection to reality. Bilateral stimulation can worsen confusion, disorientation, and positive symptoms. |
| Epilepsy and seizure disorders (especially photosensitive epilepsy) | Visual stimulation (eye movements) and auditory signals can trigger an epileptic seizure. |
| Severe dissociative disorders (in an active, uncompensated stage) | EMDR may worsen dissociation rather than help resolve it. Long-term stabilization is required first. |
| Organic brain lesions (in the stage of decompensation) | Impaired brain function makes information processing unpredictable and potentially dangerous. |
| Acute state after severe trauma (first days/weeks) | Stabilization and creation of a safe space are necessary first. Trauma processing begins later, when the client is ready. |
Relative Contraindications (Requires Caution and Consultation)
In these cases, the method may be used, but only under strict conditions: after consultation with a relevant physician and under the constant supervision of a certified EMDR therapist.
| Condition / Factor | Necessary Precautions |
|---|---|
| Severe cardiovascular disease (unstable angina, severe hypertension, arrhythmias) | Intense emotional reactions during the session can cause sharp blood pressure spikes and tachycardia. Monitoring by a physician/cardiologist is required. |
| Pregnancy (especially with complications or in late stages) | EMDR is not contraindicated but requires special care. It is important to avoid working with deep trauma that could cause severe stress. Consultation with an obstetrician-gynecologist is mandatory. |
| Severe depression with suicidal thoughts | Therapy should only take place in an inpatient setting or under constant psychiatric supervision. EMDR may be used as an adjunct to primary therapy, but not as the sole method. |
| Glaucoma and severe retinal diseases | Visual stimulation can create excessive eye strain. In such cases, only tactile or auditory stimulation should be used. |
| Use of psychoactive substances (including alcohol) on the day of the session | Any altered state of consciousness makes the processing unsafe and unpredictable. |
| Neurological disorders | A neurologist's clearance is required to ensure the method can be applied without risk of deterioration. |
When Self-Practice Is Absolutely Forbidden
We always emphasize that tools for self-help, such as the BLS Ball Stimulator or the Butterfly Hug, are designed for mild self-help (relieving everyday stress, anxiety before an event). However, it is strictly forbidden to use them for self-help when dealing with:
- PTSD and severe trauma — a specialist is required.
- Panic attacks — a professional protocol is needed.
- Conditions described in the sections above (absolute and relative contraindications).
In these cases, seeing a certified EMDR therapist is mandatory for safety.
Why This Matters: EEAT and Safety
Our approach to informing about contraindications is based on the principles of EEAT (Experience, Expertise, Authoritativeness, Trustworthiness) and clinical guidelines:
- We rely on data from the WHO and clinical guidelines from leading international health organizations .
- We do not provide recommendations for self-treatment of serious disorders.
- We urge mandatory diagnosis by a specialist before starting therapy.
This is critically important because, according to research, some methodological limitations in EMDR studies (for example, the fact that both participants and therapists knew who was receiving EMDR and who was not) create risks of systematic bias. We must be transparent and honest with our users.
Conclusion
EMDR is not a magic pill, but a serious psychotherapeutic method. Its effectiveness is confirmed for many conditions, but safety always comes first. If you are unsure whether you have contraindications, be sure to consult with a physician or our specialist.
Explore our other pages to make an informed decision:
- What is EMDR and who can it help?
- How does the method work?
- Indications for EMDR use
- Find a certified EMDR therapist
Sources
- World Health Organization. Guidelines for the management of conditions specifically related to stress. Geneva, WHO.
- American Psychiatric Association. Practice Guideline for the Treatment of Patients With Acute Stress Disorder and Posttraumatic Stress Disorder.
- Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. 3rd ed. New York: Guilford Press.
- EMDR International Association (EMDRIA). EMDR Therapy and Dissociative Disorders.
- National Center for PTSD. U.S. Department of Veterans Affairs. PTSD and Physical Health.
- NICE Guideline [NG116]. Post-traumatic stress disorder. 2022.
- Villegas-Ortega J, et al. Effects of EMDR vs. waiting list for adults with PTSD: Systematic review and meta-analysis. Journal of Affective Disorders, 2025.
- de Jongh A, et al. The state of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress, 2024.
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"content": "EMDR (Eye Movement Desensitization and Reprocessing) is a powerful and effective psychotherapy method, recognized by the WHO and included in clinical guidelines worldwide for treating PTSD and other conditions. However, like any therapeutic tool, it has its contraindications and limitations.\n\nClient safety is the top priority. In this article, we will examine in detail when EMDR should not be used, when special caution is required, and when it should only be used in conjunction with a medical professional.\n\n## Absolute Contraindications\n\nIn these cases, the use of EMDR is strictly prohibited, as it may cause serious harm.\n\n| Contraindication | Why It Matters |\n|--|--|\n| Psychotic disorders (schizophrenia, schizoaffective disorder, delusions, hallucinations in the active phase) | The method requires a stable connection to reality. Bilateral stimulation can worsen confusion, disorientation, and positive symptoms. |\n| Epilepsy and seizure disorders (especially photosensitive epilepsy) | Visual stimulation (eye movements) and auditory signals can trigger an epileptic seizure. |\n| Severe dissociative disorders (in an active, uncompensated stage) | EMDR may worsen dissociation rather than help resolve it. Long-term stabilization is required first. |\n| Organic brain lesions (in the stage of decompensation) | Impaired brain function makes information processing unpredictable and potentially dangerous. |\n| Acute state after severe trauma (first days/weeks) | Stabilization and creation of a safe space are necessary first. Trauma processing begins later, when the client is ready. |\n\n## Relative Contraindications (Requires Caution and Consultation)\n\nIn these cases, the method may be used, but only under strict conditions: after consultation with a relevant physician and under the constant supervision of a certified EMDR therapist.\n\n| Condition / Factor | Necessary Precautions |\n|--|--|\n| Severe cardiovascular disease (unstable angina, severe hypertension, arrhythmias) | Intense emotional reactions during the session can cause sharp blood pressure spikes and tachycardia. Monitoring by a physician/cardiologist is required. |\n| Pregnancy (especially with complications or in late stages) | EMDR is not contraindicated but requires special care. It is important to avoid working with deep trauma that could cause severe stress. Consultation with an obstetrician-gynecologist is mandatory. |\n| Severe depression with suicidal thoughts | Therapy should only take place in an inpatient setting or under constant psychiatric supervision. EMDR may be used as an adjunct to primary therapy, but not as the sole method. |\n| Glaucoma and severe retinal diseases | Visual stimulation can create excessive eye strain. In such cases, only tactile or auditory stimulation should be used. |\n| Use of psychoactive substances (including alcohol) on the day of the session | Any altered state of consciousness makes the processing unsafe and unpredictable. |\n| Neurological disorders | A neurologist's clearance is required to ensure the method can be applied without risk of deterioration. |\n\n## When Self-Practice Is Absolutely Forbidden\n\nWe always emphasize that tools for self-help, such as the [BLS Ball Stimulator](https://blsnow.io/en/tools/bls-ball) or the [Butterfly Hug](https://blsnow.io/en/articles/butterfly-hug), are designed for **mild self-help** (relieving everyday stress, anxiety before an event). However, it is **strictly forbidden** to use them for self-help when dealing with:\n\n- **PTSD and severe trauma** — a specialist is required.\n- **Panic attacks** — a professional protocol is needed.\n- **Conditions described in the sections above** (absolute and relative contraindications).\n\nIn these cases, seeing a [certified EMDR therapist](https://blsnow.io/en/specialists) is **mandatory for safety**.\n\n## Why This Matters: EEAT and Safety\n\nOur approach to informing about contraindications is based on the principles of **EEAT** (Experience, Expertise, Authoritativeness, Trustworthiness) and clinical guidelines:\n\n- We rely on data from the **WHO** and clinical guidelines from leading international health organizations .\n- We do not provide recommendations for self-treatment of serious disorders.\n- We urge mandatory diagnosis by a specialist before starting therapy.\n\nThis is critically important because, according to research, some methodological limitations in EMDR studies (for example, the fact that both participants and therapists knew who was receiving EMDR and who was not) create risks of systematic bias. We must be transparent and honest with our users.\n\n## Conclusion\n\nEMDR is not a magic pill, but a serious psychotherapeutic method. Its effectiveness is confirmed for many conditions, but safety always comes first. If you are unsure whether you have contraindications, be sure to consult with a physician or our specialist.\n\nExplore our other pages to make an informed decision:\n\n- [What is EMDR and who can it help?](https://blsnow.io/en/articles/what-is-emdr)\n- [How does the method work?](https://blsnow.io/en/articles/how-emdr-works)\n- [Indications for EMDR use](https://blsnow.io/en/articles/emdr-for-ptsd)\n- [Find a certified EMDR therapist](https://blsnow.io/en/specialists)\n\n## Sources\n\n1. [World Health Organization. Guidelines for the management of conditions specifically related to stress. Geneva, WHO.](https://www.who.int/publications/i/item/9789241550079)\n2. [American Psychiatric Association. Practice Guideline for the Treatment of Patients With Acute Stress Disorder and Posttraumatic Stress Disorder.](https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines)\n3. Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. 3rd ed. New York: Guilford Press.\n4. [EMDR International Association (EMDRIA). EMDR Therapy and Dissociative Disorders.](https://www.emdria.org/)\n5. [National Center for PTSD. U.S. Department of Veterans Affairs. PTSD and Physical Health.](https://www.ptsd.va.gov/)\n6. [NICE Guideline [NG116]. Post-traumatic stress disorder. 2022.](https://www.nice.org.uk/guidance/ng116)\n7. [Villegas-Ortega J, et al. Effects of EMDR vs. waiting list for adults with PTSD: Systematic review and meta-analysis. Journal of Affective Disorders, 2025.](https://www.sciencedirect.com/science/article/abs/pii/S0165032725015769)\n8. [de Jongh A, et al. The state of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress, 2024.](https://onlinelibrary.wiley.com/doi/10.1002/jts.23012)",
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