Can EMDR Therapy Trigger Manic Episodes in Bipolar Patients?

Understanding How EMDR Therapy Can Affect Bipolar Disorder

Bipolar disorder, formerly known as manic depression, is a mental health condition characterized by extreme shifts in mood and energy levels. Patients experience both manic and depressive episodes that can vary in length and severity. Mania often presents as an elevated mood with increased energy, racing thoughts, and risk-taking behaviors. The depressive phase brings low mood, fatigue, loss of interest in normal activities, and suicidal ideation in acute cases.

Treatment for bipolar disorder aims to reduce the intensity and frequency of mood episodes to allow patients to live more stable, fulfilling lives. Medications such as lithium and anticonvulsants are often prescribed to balance brain chemistry. Psychotherapy is used in conjunction to promote healthy coping strategies. One type that is sometimes utilized is eye movement desensitization and reprocessing (EMDR). This technique was originally designed to treat post-traumatic stress disorder but is now being applied to other conditions as well.

What is EMDR and How Does it Work?

EMDR therapy uses bilateral stimulation, often in the form of guided eye movements, while the patient focuses on traumatic memories and related cognitive distortions or negative beliefs. The mechanisms through which EMDR achieves its effects are not conclusively understood. Still, research indicates that the alternating bilateral stimulation in some way disrupts the brain's established neurological patterns around the traumatic memory. This makes new associations possible so that the memory loses its power over the patient’s functioning.

Several theories have been put forward about the inner workings of EMDR. The working memory theory postulates that the dual attention demand of tracking the bilateral stimulus while concentrating on the trauma taxes working memory. This causes the traumatic memory to become less vivid and emotional over time. The orienting response theory focuses on changes to the body’s fight-or-flight reaction to perceived threats. The REM sleep theory notes similarities between EMDR and the eye movements of rapid eye movement sleep, which is important for memory processing and regulation of strong emotions.

Does EMDR Have Any Risks for Bipolar Patients?

EMDR is an intense process of reprocessing traumatic memories and related negative self-concepts that can be psychologically and emotionally demanding. As such, there are some risks inherent in using this technique with bipolar patients who may have heightened sensitivity to emotional flooding or stressors that provoke mood episodes. The very factors that make EMDR effective in treating PTSD could also trigger manic or depressive symptoms if the patient becomes overly taxed or destabilized by the experience.

Several case studies have noted EMDR triggering manic and mixed episodes in patients with underlying bipolar vulnerability. Rapid reprocessing of traumatic memories paired with the intensity of bilateral eye movements may overstimulate bipolar brains and disrupt mood equilibrium. There are also indications that EMDR could worsen psychotic symptoms in some patients or unearth traumatic memories before they are prepared to constructively handle them.

Precautions for Using EMDR with Bipolar Clients

These risks do not preclude the use of EMDR for bipolar disorder but do require certain precautions to ensure the patient’s safety. Thorough screening for manic risk factors, psychotic features, and suicide risk should be conducted beforehand. The therapist must also monitor mood symptoms carefully throughout treatment. EMDR sessions may need to be shorter with more time for relaxation techniques to minimize activation effects. The eye movements could be conducted at a slower pace as well.

Medications may need to be adjusted to ensure stability, and patients should be educated on warning signs like sleep disturbances, irritability, racing thoughts, etc. so they can notify their treatment team if destabilization occurs. EMDR should be introduced cautiously, starting with less distressing memories until the patient demonstrates tolerance of bilateral stimulation methods. With proper precautions and monitoring, many patients benefit greatly from EMDR’s integration into a comprehensive bipolar treatment plan.

Other PTSD Therapies to Consider

If EMDR seems too risky, other evidence-based PTSD treatments may be better options for patients with bipolar disorder. Some alternatives to explore include:

• Cognitive Processing Therapy
• Prolonged Exposure Therapy
• Stress Inoculation Training
• Cognitive Behavioral Therapy
• Dialectical Behavior Therapy

The most important factor is finding a therapy tailored to the individual’s needs and conducted by a specialist familiar with bipolar mood concerns. With mindfulness and proper support, healing from PTSD is possible without triggering significant mood disruptions.

Tips For Preventing Manic and Depressive Episodes

Because bipolar disorder is a lifelong condition, episodes are often recurring even with treatment. Patients can reduce frequency and severity significantly by identifying and managing common triggers. This empowers individuals to exert more control over their health through lifestyle adjustments and self-care skills.

Watch For These Common Manic Triggers:

• Disrupting sleep-wake cycles
• High stress levels
• Alcohol or drug use
• Missing medication doses
• Major life changes or events

Prioritizing restful sleep, maintaining medication routines, and managing stress through healthy outlets like exercise, meditation, massage, etc. can help stabilize mood. Some dietary modifications like limiting caffeine and ensuring adequate nutrients also promote equilibrium. Adding structure and routine boosts consistency and keeps disruptive variables in check.

Signs That A Manic Phase Is Developing Include:

• Decreased need for sleep
• Rapid or racing thoughts
• Extreme optimism or goal-directed activity
• Excessive talking or jumping from topic to topic
• Impulsive or risky behavior such as spending sprees, reckless driving, impulsive travel

Consulting health providers at the first signs allows for medication adjustments and emergency interventions if needed to mitigate severity. Having a solid mania prevention plan with coping strategies and trusted supports in place enables patients to get through episodes with less disruption to their lives.

Factors That Can Precipitate Depressive Phases:

• High stress
• Grief or traumatic events
• Major illness or pain
• Hormonal changes like postpartum or perimenopause
• Loneliness and social isolation
• Low light exposure from winter or inconsistent sleep routines
• Certain medications like steroids or blood pressure treatments

A holistic self-care plan addressing physical, mental, social, emotional, and spiritual facets of wellness enables patients to bounce back from these downswings more readily. Support groups can offset isolation while stress management limits overwhelm. Light therapy lamps counteract winter blues and mood journals identify triggers for lifestyle modifications. The key is tailoring prevention strategies to the individual.

Some Early Warning Signs of Depression Include:

• Sleeping too much or too little
• Fatigue, low energy
• Withdrawing from people and activities
• Feeling worthless or guilty
• Crying spells or loneliness
• Lack of concentration or motivation
• Changes in appetite and weight

Suicidal thoughts may emerge in severe cases. At any indications of a looming depressive phase, patients should consult their treatment team about medication adjustments, psychotherapy boosters, and lifestyle changes to mitigate severity. Having go-to mood lifting strategies gives a sense of control.

In Summary

Bipolar disorder certainly brings unique challenges, but through medication compliance, trigger avoidance, early intervention for mood swings, strong supports, and adaptive coping strategies, patients can reduce episodes and lead very fulfilling lives. Therapeutic modalities like EMDR require special precautions for this population but can still be applied successfully under expert care. Mitigating risk factors and listening to warning signs allows individuals to manage bipolar disorder instead of feeling controlled by it.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.