How EMDR Can Support Emotional Recovery After Brain Injury

How EMDR Can Support Emotional Recovery After Brain Injury

Understanding the Emotional Impact of Brain Injury

A traumatic brain injury (TBI) can have profound effects on a person’s life, not only physically and cognitively but also emotionally. Many people experience significant changes in mood, anxiety, and stress levels after their injury.  Rates of anxiety, depression, and post-traumatic stress disorder (PTSD) are noticeably higher in people recovering from moderate to severe TBI. Eye Movement Desensitisation and Reprocessing (EMDR) is an evidence-based therapy recommended for PTSD.

Can PTSD Develop Without Memory of the Trauma?

Although it might seem counterintuitive, research now shows that PTSD can develop even when someone has no clear memory of the event that caused their injury. This may be due to:

• Implicit memory of bodily sensations or emotional reactions
• Fear conditioning, where the nervous system encodes the danger response
• Fragmented information pieced together after the event
• Traumatic moments following recovery, such as hearing what happened

This means that a person with a severe TBI can still experience intrusive feelings, anxiety, hypervigilance, or avoidance, even if they cannot recall the traumatic event itself.

Why EMDR Is Particularly Suited to Brain Injury Rehabilitation

Unlike some other trauma-focused therapies, EMDR does not rely on detailed verbal recall of the traumatic incident. This makes it especially helpful for people with memory impairments, reduced language abilities, or slowed information processing after a brain injury.

EMDR may be beneficial after TBI because:

• It does not require a full trauma narrative, which is often difficult after brain injury.
• It allows people to work with feelings or bodily sensations when memories are fragmented or absent.
• It can reduce emotional distress quickly, which is advantageous for people who fatigue easily.
• It can be adapted using cognitive rehabilitation strategies to support attention, memory, and comprehension.

Adapting EMDR for People With Cognitive Difficulties

Recent clinical work has explored how EMDR can be tailored for individuals with moderate to severe TBI. Therapists may:

• Reduce distractions and simplify language
• Use written prompts, visual aids, or memory cues
• Offer options for negative or positive beliefs when self-generating them is difficult
• Use tactile or auditory stimulation instead of eye movements for those with visual or spatial difficulties
• Keep sessions shorter to reduce fatigue

These practical adjustments help ensure the therapy remains accessible and effective even for people with substantial cognitive impairments.

A Case Example: Rapid Change Even After Severe Memory Problems

In one recent case study co-authored by Dr Sara Simblett, CEO of The London Neurocognitive Clinic, a woman with severe TBI—who had significant memory loss, reduced attention, and cognitive slowing—completed a single EMDR session targeting the distress she experienced when she first woke after her accident. Despite her cognitive challenges, the adapted EMDR session led to:

• Complete resolution of distress linked to the memory
• Major reduction in PTSD and anxiety symptoms
• Improved engagement in rehabilitation over the following months

This suggests that the emotional processing required for EMDR does not solely rely on explicit memory or high cognitive functioning.

The Potential of EMDR in Neurorehabilitation

Although more research is needed, growing evidence indicates that EMDR can be a safe, flexible, and effective therapeutic option for people recovering from brain injuries. It may help reduce emotional distress, improve participation in rehabilitation, and contribute to better overall recovery.

At The London Neurocognitive Clinic, we recognise the value of integrating psychological therapy into neurorehabilitation to support both emotional and cognitive wellbeing. EMDR is one of several approaches that can be adapted to meet the needs of individuals living with the complex consequences of brain injury