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

Background/Objectives: Emotion regulation may be relevant to trauma processing during 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 regulation, emotional processing, rumination, alexithymia, childhood trauma, and psychological symptom severity; therapists completed the Processing Difficulties Scale (PDS). Analyses included Pearson correlations with Benjamini-Hochberg false discovery rate correction, 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 multivariable 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), hypothetical 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). Models 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 differentially associated with trauma-processing patterns during EMDR. The cross-sectional design and modest explanatory capacity of the models preclude causal or temporal interpretations. Prospective studies are needed to assess the predictive and clinical utility of the PDS.