EMDR vs. IRRT: Which Trauma Therapy is Right for You?

Understanding the Impact of Trauma

Navigating the world of trauma therapy can feel overwhelming, with many different approaches available. Before diving into specific therapeutic methods, it's essential to understand the different ways trauma can manifest. While everyone's experience is unique, trauma can lead to a range of symptoms and conditions, most notably Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (C-PTSD).

PTSD, often associated with a single, life-threatening event like a car accident or a natural disaster, is characterized by four main symptom clusters:

· Intrusive Memories: This includes unwanted and distressing thoughts, flashbacks, or nightmares that make you feel like you are reliving the event.

· Avoidance: You may actively try to avoid places, people, or activities that remind you of the trauma, leading to emotional numbness and a feeling of detachment.

· Negative Changes in Thinking and Mood: This can involve negative beliefs about yourself or the world, feelings of shame, guilt, or hopelessness, and a loss of interest in activities you once enjoyed.

· Changes in Arousal and Reactivity: You might be easily startled, constantly on guard for danger (hypervigilance), have trouble sleeping or concentrating, or experience angry outbursts.

C-PTSD is a more severe form of trauma response that arises from prolonged or repeated traumatic events, often in childhood. This can include long-term abuse, neglect, or living in a state of captivity from which escape was difficult or impossible. In addition to the core PTSD symptoms, C-PTSD includes a cluster of three additional challenges:

· Difficulties with Emotional Regulation: This involves intense and often unpredictable emotional reactions, such as explosive anger or chronic sadness.

· A Negative Sense of Self: You may struggle with feelings of worthlessness, deep shame, or guilt, and a persistent belief that you are permanently damaged.

· Relationship Problems: It can be difficult to form and maintain healthy relationships, as trust issues, a fear of abandonment, and a tendency to repeat unhealthy relational patterns often arise.

Understanding these distinctions can help you better identify your own experience and find a trauma-focused therapy that addresses your specific needs. Two evidence-based methods are Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting and Reprocessing Therapy (IRRT). Both EMDR and IRRT have proven effective in treating these conditions, but they do so in fundamentally different ways.

What is EMDR?

EMDR is a structured psychotherapy that operates on the principle that traumatic memories get improperly stored in the brain, leading to distressing symptoms like flashbacks and emotional distress. The core of EMDR is the use of bilateral stimulation—typically side-to-side eye movements following the therapist's hands, but also sounds or taps. The client holds a distressing memory in their mind while this stimulation is applied. This dual-attention process is thought to mimic REM sleep, helping the brain to "reprocess" the trauma.

Key features of EMDR:

· Bilateral Stimulation: The client's eyes are open, focused on the therapist's hand movements.

· Focus on Desensitization: The primary goal is to reduce the emotional and physical intensity of the memory, making it less triggering.

· Minimal Talking: The process is largely non-verbal. Clients are not required to provide a detailed narrative of their trauma.

What is IRRT?

IRRT is a form of cognitive-behavioral therapy that focuses on actively changing the emotional and cognitive aspects of a traumatic memory while also reducing flashbacks and emotional distress. Instead of bilateral stimulation, IRRT uses guided imagery to "rescript” or rewrite the distressing memory. The client, with eyes closed, revisits a traumatic image in their mind, and with the therapist's guidance, actively intervenes to create a new, empowering outcome. This may also include confronting a perpetrator within the memory, a key step toward reclaiming personal power. The goal is to transform the memory from a place of helplessness to one of agency. Clients often feel a sense of empowerment, as if a weight has been lifted

Key features of IRRT:

· Guided Imagery & Rescripting: The client's eyes are closed, allowing for a deep, immersive visualisation experience.

· Focus on Reprocessing & Rescripting: The process involves actively changing the memory's narrative and emotional content.

· Continuous Verbal Contact: The client and therapist stay in constant conversation. The therapist guides the client step-by-step through the memory to support the client in changing it and to overcome emotional blocks if they arise. Clients often state that without the therapist’s guidance they wouldn’t have been able to go to those deep, and potentially painful places and would have became too overwhelmed. The constant verbal contact feels grounding to clients.

The Pathways to Healing: A Deeper Dive

A study by Alligerhorn, C. et al. (2015) showed that both EMDR and IRRT are just as effective in reducing PTSD symptoms, their methods for achieving those results are different. It's a classic case of "many roads lead to Rome."

· EMDR and Desensitization: The EMDR process is about desensitization. The client speaks very little, and the therapist does not guide them to change the content of the memory itself. Instead, the focus is on enabling the brain's natural ability to process the trauma, so it loses its emotional charge. The memory is still there, but it no longer holds the same power. This desensitization can directly lead to the elimination of flashbacks and nightmares, as the brain no longer treats the memory as an active threat.

· IRRT and Empowerment: IRRT, by contrast, is a more active and empowering process centered on reprocessing and rescripting. It allows the client to be seen in their trauma story and find the words to speak about what happened. This verbal and visual engagement with the narrative is empowering and allows for a profound sense of validation as the client shares their experience with a compassionate therapist. Just like EMDR, the act of reliving the traumatic event and rescripting it in a safe, controlled environment can also eliminate flashbacks and nightmares.

The Similarities and How They Differ

Both EMDR and IRRT involve an element of exposure to the traumatic memory, which is a key component of effective trauma therapy. The client must, in some way, confront what happened to them.

· In EMDR, this exposure is brief and controlled. The client brings the memory to mind (thinking about it) while the bilateral stimulation helps to process it. The therapist also works with the client to install a positive belief to replace the negative one, and uses a body scan to ensure any physical sensations related to the trauma are resolved.

· In IRRT, the exposure is more immersive. The client actively visualises and talks about what is happening in the memory, step by step. To this exposure, IRRT adds the active element of rescripting (e.g., confronting and disempowering the perpetrator) and self-soothing, which are central to the process.

Beyond the Mechanics: Inner Child Work and Self-Compassion

One of the most powerful and unique aspects of IRRT is its integration of deep self-soothing. The therapy helps clients take care of their younger selves within the traumatic memory. By comforting, protecting, and validating that younger self, clients are not just changing the memory but fundamentally providing themselves with what they would have needed back then. It also strengthens their relationship with themselves.

IRRT places a big focus on building self-compassion and emotional regulation. The client learns to sit with discomfort and practice self-soothing, building an internal sense of safety and a compassionate inner voice. This work goes beyond processing a specific event; it creates a lasting foundation of self-worth and resilience that helps clients navigate future challenges with greater ease and well-being. This integration of self-soothing into the work is a key feature of IRRT.

An extension of IRRT is inner child work, which focuses on self-soothing without processing any traumatic memory. To learn more about this, read our blog post on the topic.

Which Trauma Therapy is Right for You?

The choice between these two trauma therapies often comes down to individual preference and the nature of your experience.

· EMDR may be a good fit if you prefer a non-verbal, neurological processing which can feel safe and contained. You won’t need to talk in detail about your trauma with your therapist.

· IRRT might be right if you are looking for a deep, emotional way of processing all the nuances of your trauma. This might include feelings of shame, guilt and anger. You will actively engage with your story, gain a sense of agency over the narrative, and build a stronger, more compassionate relationship with yourself.

Ultimately, both EMDR and IRRT are highly effective tools for trauma recovery. The most important step is to find a qualified and compassionate trauma therapist who can guide you through the process, regardless of the method you choose.

For Therapists & Colleagues: If you are a therapist curious to learn more about IRRT, I am happy to connect and discuss how this powerful modality can benefit your practice.

Ready for Transformation? Please reach out to schedule an IRRT consultation and to start feeling better soon.

Samantha Duroska is a Clinical Psychologist and IRRT Therapist in Coffs Harbour offering trauma therapy in person and online telehealth Australia-wide. She is passionate about the profound emotional transformations IRRT provides for her clients.

Alligerhorn, C., Mitte, K., Zimmermann, P. (2015). Vergleichende Wirksamkeit von IRRT und EMDR  bei kriegstraumatisierten deutschen Soldaten. Trauma und Gewalt; 9(3): 204 – 215.