Predictive processing and candidate change processes in EMDR therapy: a transdiagnostic framework

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a first-line treatment for posttraumatic stress disorder (PTSD). It is increasingly applied beyond PTSD to conditions like substance use disorders (SUDs) and body-focused repetitive behaviors (BFRBs). However, outcomes for conditions outside PTSD are often mixed, particularly for craving, relapse, and repetitive behavioral endpoints. Existing clinical models can be helpful but lack specific guidance on EMDR procedures in such cases. Extending previous predictive processing (PP) accounts of EMDR that have focused primarily on PTSD and traumatic memory, we propose a transdiagnostic framework informed by PP theory. Therein, psychopathology is the result of the persistence of overly precise, maladaptive predictions that guide perception, bodily experience, emotion, and action, despite contradictory sensory input. We hypothesize that PTSD, SUDs, and BFRBs differ in the focal content, hierarchical level, temporal scope, and automaticity (proceduralization) of dominant predictions. Predictions associated with PTSD concern threat and safety, in SUDs reward and relief, and in BFRBs sensory-interoceptive urges and action tendencies. We describe candidate processes according to their function in change: access and target selection, working-memory taxation, proximal attenuation of defensive processing and prediction dominance, and subsequent learning/integration processes: prediction-error-relevant updating and hierarchical integration. The framework is hypothesis-generating and aims to clarify EMDR’s broad but non-uniform effects, inform target-sensitive procedure selection and guide future research.