The Role of Emotion Regulation in Trauma Processing During Eye Movement Desensitization and Reprocessing (EMDR) Therapy

Abstract

Abstract Background/Objectives: Emotion regulation may be relevant to trauma processing dur- ing Eye Movement Desensitization and Reprocessing (EMDR) therapy, but associations between specific regulatory processes and distinct processing patterns remain unclear. This study examined these associations and cross-sectional indirect associations with symptom severity. Methods: This multicenter cross-sectional study included 116 patients receiving EMDR therapy between 2023 and 2025. Patients completed measures of emotion regula- tion, emotional processing, rumination, alexithymia, childhood trauma, and psychological symptom severity; therapists completed the Processing Difficulties Scale (PDS). Analy- ses included Pearson correlations with Benjamini–Hochberg false discovery rate correc- tion, multivariable linear regression, and bootstrap cross-sectional indirect-effect analyses. Results: Overall emotion regulation difficulties were not significantly associated with any PDS dimension, whereas specific processes showed distinct bivariate associations. In multi- variable linear regression models, lower emotional awareness was independently associated with greater Lack of Generalization and/or Absence of Changes (β=−0.215, p = 0.028), hy- pothetical thinking with greater Poor Emotional Processing (β= 0.235, p = 0.011), and more EMDR processing sessions with greater Loss of Dual Attention (β= 0.264, p = 0.005). Mod- els explained 5.5–18.4% of the variance. Lower emotional awareness showed a significant cross-sectional indirect association with symptom severity through Lack of Generalization and/or Absence of Changes. Conclusions: Specific emotional-cognitive processes were dif- ferentially associated with trauma-processing patterns during EMDR. The cross-sectional design and modest explanatory capacity of the models preclude causal or temporal inter- pretations. Prospective studies are needed to assess the predictive and clinical utility of the PDS.