New Perspectives on EMDR and Chronic Pain

One of the things I value about being a therapist is that the learning never really stops. Our understanding of the brain, trauma, pain and psychological therapy continues to develop, creating new possibilities not only for therapists, but ultimately for the people who come to us for help.

I first had the opportunity to learn from Australian psychologist Mark Grant when he came to London in 2012. Mark has specialised for many years in the use of EMDR with chronic pain, and I am delighted that, fourteen years later, I have the opportunity to learn from him again. This time, rather than Mark travelling to London, I am joining a series of live webinars he is delivering from Australia, timed to enable therapists in Europe to participate.

My own learning about pain, trauma and their treatment has continued throughout those intervening years, through different areas of training and clinical practice. What feels particularly valuable now is the opportunity to return to Mark's work and discover how his own thinking and clinical approach have evolved. It allows me to look again at chronic pain specifically through his perspective, while bringing to that learning the knowledge and experience I have developed since we first met in 2012.

For me, continuing professional development is about remaining curious. However experienced we become, there is always more to understand and another perspective from which to look at something familiar. I feel very fortunate to have this opportunity to deepen my understanding of chronic pain from Mark's particular perspective and to consider how his developing work may further inform my own.

OCD and confidence: why feeling uncertain doesn’t mean you need to check again

People with OCD often describe a powerful sense of doubt: “What if I’ve missed something?” or “What if I’m not really sure?” That feeling of uncertainty can drive checking, reassurance-seeking and repeated mental reviewing. Recent research has highlighted an interesting pattern in OCD, where people may have lower overall confidence even when they are still able to respond appropriately to the evidence in front of them. In other words, the feeling of uncertainty does not necessarily mean that something is actually wrong or that more checking is needed.

This is where approaches such as Exposure and Response Prevention (ERP) and Metacognitive Therapy (MCT) can be helpful. ERP involves learning to tolerate uncertainty without carrying out the usual compulsive response, while MCT focuses on the beliefs and thinking processes that keep doubt and threat-monitoring going. 

In my work, the aim is not to help people achieve perfect certainty, but to help them become less governed by the need for it.

OCD thoughts can feel frightening – but what do they actually mean?

How ERP and Metacognitive Therapy can help change your relationship with intrusive thoughts

People with OCD can experience intrusive thoughts, images or impulses that feel deeply upsetting precisely because they seem so out of character. A person may become frightened not only by the thought itself, but by what they think having the thought says about them. Yet unwanted intrusive thoughts are not the same as intentions, wishes or actions.

One of the things that can keep OCD going is the attempt to work out what a thought “really means”, gain certainty about it, or neutralise the anxiety it creates. This can lead to checking, reassurance-seeking, avoidance or repeated mental reviewing. From a Metacognitive Therapy (MCT) perspective, an important part of the problem is not simply the presence of the intrusive thought, but the beliefs we hold about the significance of that thought and the ways we respond to it through worry, monitoring and attempts to control it.

Exposure and Response Prevention (ERP), a well-established CBT treatment for OCD, can also help people change their relationship with intrusive thoughts. By gradually facing feared situations, thoughts or uncertainties while reducing compulsive responses, people can learn that they do not need to neutralise, avoid or gain certainty about every intrusive experience. Over time, the thought can become less important and less powerful.

In my work at Symmetry CBT, I help people experiencing OCD and intrusive thoughts, including thoughts that can feel embarrassing, disturbing or difficult to talk about. Therapy offers a confidential space to understand what is keeping the problem going and to develop a different way of responding, so that intrusive thoughts no longer have to dominate attention or behaviour.

Trauma-focused CBT or EMDR – does having a choice matter?

Trauma-focused CBT or EMDR – does having a choice matter?

When people seek therapy for post-traumatic stress disorder (PTSD), they may be offered different evidence-based treatments. Two of the main approaches recommended by NICE are trauma-focused Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR). A new study from a South London NHS Talking Therapies service has looked at how these two approaches compare in everyday clinical practice.

The researchers found that both EMDR and trauma-focused CBT produced similarly good outcomes across different types of trauma and different groups of clients. There was no clear indication that one treatment was consistently better than the other. This supports the idea that, when both treatments are suitable and available, the individual’s own preference can reasonably play an important part in deciding which approach to use.

The study also highlighted something equally important: some people stopped therapy around the point at which treatment began to focus more directly on traumatic memories. Trauma therapy can understandably feel daunting, and the researchers suggest that careful preparation and discussion about what memory-focused work involves may help people remain engaged with treatment. Sarah has found over many years of clinical work that good preparation often makes a real difference, helping people feel more able to engage with trauma-focused therapy when they are ready to do so.

For someone considering therapy for trauma, the question therefore may not simply be “Which treatment is best?” A more useful discussion may be about how the different therapies work, what feels acceptable to the individual, and which approach they feel most able to engage with. Good trauma therapy should be collaborative rather than something that is simply done to a person.

At Symmetry CBT, Sarah works with both CBT and EMDR when helping people with traumatic experiences and PTSD. Having experience in more than one trauma-focused therapy allows the treatment discussion to take account of the individual person, their difficulties and their preferences, rather than starting from the assumption that one approach will suit everybody.

Using Music in EMDR 🎶

In early May 2026, I attended a workshop presented by Cassandra Manning MA, MSc on her EMDR+Music Integrated Model©: Using Music as an Interweave in EMDR©.

EMDR is already a powerful and well-established therapy approach, and many people benefit greatly from it.

At times, though, some people can find themselves worrying during EMDR:

• “Am I processing properly?”
• “Am I getting it right?”
• “Am I failing because nothing seems to be happening?”

As a practitioner, I already try to create a therapeutic space where there is less pressure to perform or force experience. What interested me about the use of music was the possibility that it might help people who become stuck, overthink the process, or go round in circles during therapy.

During the workshop, we practised experiencing EMDR ourselves in the role of client, which is an important part of learning any therapy approach as a practitioner.

I chose to work on a recent loss. What surprised me was the sense of spaciousness that emerged when music was introduced. I felt at ease with the loss in a grounded way. I noticed something had gently shifted in the way I was holding it.

As someone who has always loved music, I came away feeling genuinely interested in the possibilities this approach may offer for some people, particularly those who feel drawn to music, who become stuck in overthinking during therapy, or who feel apprehensive about EMDR itself.

I am introducing EMDR+Music into my practice for clients who feel it may be helpful for them.

Sarah 

Metacognitive Therapy (MCT), EMDR and DBR for health anxiety

I came to therapy struggling with overwhelming health anxiety that was affecting nearly every part of my life. I was stuck in worry, fear and always assuming the worst.

Working with Sarah has been life changing. We started with metacognitive therapy (MCT) which helped me control my worrying. It was really powerful when we explored and weakened my metacognitive beliefs about my health. The techniques and tools that I learned from these sessions opened my eyes to a new way of thinking and being. We did some Deep Brain Reorienting (DBR), which I found fascinating. 

My therapy also touched on other areas other than health anxiety, and I liked the way we worked together to decide what each session would look like. I now have a stronger sense of self. I just feel wiser, more resilient and hopeful. I am really grateful for Sarah’s expertise, compassion and patience throughout my journey. 

 (Online, female, aged 39, September 2025)

Ovarian Hyperstimulation Syndrome (OHSS)

What is Ovarian Hyperstimulation Syndrome (OHSS)?

Ovarian Hyperstimulation Syndrome (OHSS) is a medical condition that can sometimes occur as a reaction to fertility treatment, particularly during IVF. It happens when the ovaries respond too strongly to hormone medications used to encourage the development of eggs.

This can lead to the ovaries becoming swollen and painful, and fluid may leak into the abdomen and other parts of the body. In mild cases, OHSS causes bloating and discomfort, but in more severe cases, it can be extremely painful and distressing — sometimes requiring medical monitoring or hospital care.

The emotional impact

For some, OHSS is not only physically intense — it can also be emotionally shocking. The sudden onset of severe pain, the sense of the body reacting unpredictably, and the vulnerability that can arise in the midst of fertility treatment may leave deep impressions, sometimes hard to put into words.

This is where therapeutic approaches like Deep Brain Reorienting (DBR) can be helpful — offering a gentle, structured way to process the shock, fear, and overwhelm that may have become imprinted in the nervous system during or after the experience.

 Shared with permission

This is a testimonial from a client who developed OHSS after IVF treatment. She kindly agreed to share her experience of how DBR helped her process the trauma and find relief.

From Pain and Shock to Relief: Processing OHSS with DBR

I had an IVF treatment and unfortunately, I developed moderate OHSS. It felt horrendous and it was very upsetting. It was such a shock. I contacted Sarah because I was struggling with the ongoing physical pains, which resulted in me feeling depressed and lost.

Sarah used a therapy called Deep Brain Reorienting (DBR). It helped me process the trauma. After a couple of processing sessions, the pain just went. DBR helped release some trapped feelings held at a deep level that I had not been aware of before.

(Female, aged 39, online)

If you have been affected by OHSS or another physical health trauma and would like to explore whether Deep Brain Reorienting (DBR) might help, you are very welcome to get in touch.

Testimonial for help with skin picking (dermatillomania) and over-thinking using CBT (metacognitive therapy) and DBR (deep brain reorienting)

I knew I had to get some kind of control. I had reached the point where I didn’t want to go on anymore.

During my work with Sarah, I learned how to control my overthinking.  It appears my skin-picking was a coping mechanism and a stress release. As I am coping better with life’s stressors and not getting as overwhelmed by them, I am able to control the urge to pick my skin. We did some therapy on dermatillomania, which specifically targeted this condition with a positive outcome.

I now feel more content, centred, and experience more moments of peace. Life will always have its challenges but I am more equipped to deal with them, as and when they happen, rather than worrying about future events. Thoughts will obviously arise about the past but I have learned how to accept that these events are in the past and leave them alone. 

I feel I would not have been able to achieve all of this without Sarah’s support and caring approach. I found her to be extremely gifted and knowledgeable. I would highly recommend her. 

(Female age 45, mixture of online and in person therapy, May 2025)

CBT (Metacognitive Therapy), EMDR and DBR for fear of contamination from asbestos

Sarah was recommended to me when I was struggling with a dread of being contaminated by asbestos. It had reached a point that I didn’t even want to leave the house. I wouldn’t even go into the garden. I couldn’t say the word “asbestos” and if I ever heard the word, I felt sick in the pit of my stomach. I knew I needed to do something, but I didn’t want to. Finally, my family convinced me to phone Sarah. 

The CBT was effective and I made some good progress with that.  The DBR was really powerful and helped with deeper issues that were associated with my fear of asbestos, that I wasn’t aware of. I felt really comfortable with Sarah and at ease each time.  She actually listened to me and never made me feel like I was silly.

I would encourage anyone who is struggling with a fear like this to seek help as I am glad I did.

(In person, male, aged 31, Dec 2024)

Metacognitive therapy (MCT) helps with a client's reaction to an infection

A couple of years ago I had a severe and traumatic reaction to something. Unfortunately, the usual medications didn’t work for me. I struggled to find something that would work. I found the whole experience extremely distressing. Eventually I found a cure. A few months ago I worried about it returning. I started having regular and disturbing flashbacks and I didn’t know what to do. It was affecting my relationships with others. Someone recommended that I see Sarah. Within five sessions I noticed a huge change in myself. I am grateful to Sarah for giving me the help that I needed. What we did in the sessions was spot on!

(Online, male aged 23)