Hey there,

I want to talk about something that's come up a lot in consultation.

Here’s the situation:

You're working with a client who's been depressed for years. They've tried SSRIs, SNRIs, even ketamine. They've done solid CBT work. And yet they're still waking up every morning with that same crushing sense of hopelessness.

You ask about trauma history, and they say:

"I mean, nothing bad happened to me. I just... I've always felt this way."

So the question is… do you reach for EMDR, or do you assume this isn't an EMDR case?

If you're like many EMDR therapists, you probably hesitate. Because we were trained to look for Criterion A events (and when there aren't any, it's easy to think the issue is something else).

But I want to challenge that assumption, because what I've been seeing in my own practice (and what some literature seems to support) is this:

Depression can often be viewed a memory-based disorder, even when there's no capital-T Trauma.

And once you understand how to identify and target the right memories, EMDR becomes one of the most powerful tools we have for the clients who haven't responded to anything else.

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The Memories That Maintain Depression (And How to Find Them)

Before we go any further, it's important to understand this:

Depressed clients usually do have pathogenic memories driving their symptoms. A pathogenic memory is any event that created a sufficient amount of distress on the nervous system, and led to notable pathology (symptoms). They just don't always look like the memories we were trained to spot.

• No car accidents.
• No assaults.
• No life-threatening events.

Instead, you're looking for what the DeprEnd protocol calls "episode triggers": Stressful life events that preceded a depressive episode by one to two months.

These are typically attachment-related (i.e. separations, losses, humiliations, rejections, shame experiences, etc).

And what makes them distinct from other difficult memories is that when you ask about these specific memories, they light up immediately.

High SUDS.

Intrusive quality.

Often the client will say something like, "I haven't thought about that in years, but yeah... that's when I started feeling like I didn't matter anymore."

Remember, a pathogenic memory is ANY memory that causes sufficient distress that contributes to ongoing pathology (symptoms). So how do you systematically find these memories?

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3 Techniques for Identifying Depression-Maintaining Memories

I use these three approaches in almost every depression case, often in combination:

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1. Start with a symptom-event map.

This is the foundation of the DeprEnd protocol, and it is so helpful for target sequence planning. Here, you're creating a visual timeline of every depressive episode (when it started, how long it lasted, what was happening in their life 1-2 months before onset).

What you'll see are patterns that point directly to the memory networks you need to target:

• A client who gets depressed every time there's a separation
• Another who spirals after any perceived failure
• Someone whose depression always follows experiences of being dismissed or made to feel invisible.

Those patterns tell you exactly which memory networks are maintaining the depression.

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2. Explore when core negative beliefs were first learned.

When your client expresses a core negative belief (i.e. "I'm worthless," "I'm a failure," "Nothing will ever change") pause and ask:

"When in your life did you first learn to believe that?"

You may get 3-5 specific memories. List them all, then have the client rate the SUDs for each one ranging from 1 to 10.

Note: Make sure to process the highest-disturbance memory first. Often you'll see the other memories lose their charge (generalize) once you've resolved that one, because they're all feeding the same belief system.

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3. Use float-back, or somatic bridge, for memories they can't consciously access.

This is where it gets really interesting.

Once you've built enough stabilization and trust, have your client bring up a present trigger (maybe the feeling of worthlessness that showed up this morning). Then ask them to notice the image, the negative cognition, where they feel it in their body.

Then proceed with the float-back:

"Close your eyes and let your mind float back to an earlier time in your life when you've felt this same way before. Don't force anything, just allow your mind to drift back to a time when you had similar thoughts and feelings in your body."

Be patient and continue repeating variations of the prompt until they get to their earliest memories. If they keep floating back, they'll often land at a touchstone memory from childhood that established the entire belief system, a moment when a parent said they were disappointing, or a time they were publicly humiliated in school.

That's your target.

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How Processing Depression Memories Can Feel Different (And What to Watch For)

Once you've identified your targets (whether through the symptom-event map, proof memories, or float-back) the processing itself has some distinct characteristics.

The biggest difference from trauma-focused EMDR:

Negative cognitions in depression are often globally generalized, not event-specific.

In trauma work, you're typically hearing, "I'm in danger," "I can't protect myself," or "It was my fault." These are cognitions about the event.

However in depression work, you're hearing: "I am worthless," "I am a failure," "I am unlovable." These are cognitions about self (and they're absolute, not situational).

This has real implications for the installation phase of EMDR.

Then when you get to Phase 5 and you're trying to install the positive cognition, expect the VoC (Validity of Cognition scale, which measures how true a positive belief feels on a 1-7 scale) to start lower. (For example, a 2 out of 7 for "I'm okay as I am" is normal when someone's been carrying "I'm worthless" for 30 years).

Don't rush this phase.

The positive belief needs time to feel true in their body, not just make logical sense. Which brings me to the other key difference relative to trauma-focused EMDR:

Depressive states are usually felt more in the body.

Just like with trauma work, you need to be attending to somatic experiences throughout.

• Where does the worthlessness live? (I.e. gut, chest, throat, a full-body heaviness?)
• What does helplessness feel like physically? (I.e. fatigue, weakness, heaviness in limbs.)

And this is critical during Phase 5 (Installation):

During installation, emphasize installing positive somatic states (notice how embracing the positive cognition can feel light, energized, open). This is often more powerful than the cognitive piece, because many depressed clients have so rarely experienced positive physical sensations.

And here's something we love to see (it happens consistently in EMDR):

Cognitive changes happen without much cognitive work.

Once you've processed the underlying memories, the negative self-referencing thoughts often just… shift (even without additional cognitive interweaves). The client will say, "I don't know why, but 'I'm worthless' doesn't feel true anymore."

This is the AIP model doing exactly what it's designed to do.

The adaptive information was always there… it was just blocked by the pathogenic memories. Remove those blocks, and the system self-corrects.

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When Processing Gets Stuck (And What That's Telling You)

Of course, not every session goes smoothly.

Here's what I watch for when depression processing stalls, and what each pattern may be telling you:

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Looping on the same material without SUDS decreasing usually means there's a feeder memory that hasn't been accessed yet. In other words, the memory you're targeting is connected to the core issue, but it's not the source.

When this happens, I'll pause and ask:

"When you feel this feeling, does your mind want to go anywhere else? Is there an earlier time this reminds you of?"

Often they'll immediately access a memory from childhood that's been sitting underneath the whole time.

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Flat affect or dissociation during processing might mean you moved to processing too quickly. Depression often comes with significant stabilization needs (particularly when there's complex trauma or attachment disruption in the history).

If the client can't stay present with the material, go back to Phase 2. Build more resources, consider EMD to help desensitize, and lengthen your preparation phase before attempting reprocessing again.

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Negative cognitions that won't budge may need depression-specific cognitive interweaves.

For hopelessness:

• "What helped you survive that time?"
• "What does the part of you that's still here know that the hopeless part doesn't?"

For worthlessness:

• "Whose voice is that?”
• “Is that voice telling the truth?"
• "If a child told you they felt this way, what would you say to them?"

For helplessness:

• "What choices do you have now that you didn't have then?"
• "What does power or control today look like, compared to back then?"

These should be kept brief.

One sentence, then "Go with that." The goal here isn't to convince them of anything, but rather to access adaptive information that's already in their system. It’s just disconnected from the memory network you're processing.

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Depressive Relapse: Why It Happens (And How to Avoid It)

Here’s what can happen when treatment ends based on symptom relief alone:

Symptoms lift after 8-10 sessions, the client is doing better, therapy ends.

Then 6-12 months later…

They're back in a depressive episode.

Why does this happen?

When depressive symptoms re-emerge, it's likely because we didn't do the relapse prevention work, processing the fear of relapse and installing resources for future triggers.

Which is to say, relapse prevention isn't optional. Similar to the future templates with the standard protocol, it's where you lock in the gains, and it has two parts:

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1. First, process the fear of relapse itself.

Use a Future Template to target the next potential depressive episode.

• What would trigger it?
• What would it feel like?
• What's the worst part?

Many clients have significant distress just imagining getting depressed again. That distress needs to be processed, or it becomes a self-fulfilling prophecy.

Bring the new, adaptive positive cognitions into the processing and help the client visualize embodying that awareness, seeing how it can prevent or mitigate a future relapse. Strengthen with short, slow sets of BLS.

2. Install additional resources for likely trigger situations.

If your client gets depressed after separations, do Resource Development and Installation around being alone. If they spiral after perceived failures, you can install resources around self-compassion and self-worth.

DeprEnd emphasizes that clients who've had solid relapse prevention (future templates) work may dramatically lower rates of recurrence. Clients who terminate early (even with present symptom remission) may likely come back later.

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Final Thoughts

If you've been thinking EMDR is only for trauma, or if you've been hesitant to use it with your depressed clients because they don't have Criterion A events... I highly encourage you to explore this application of EMDR.

The concept of pathogenic memories that I discovered in the DeprEnd training really unlocked a new paradigm of EMDR for me. I highly recommend it.

The research is there.

The protocols are there.

And the clients who've been stuck for years… who haven't responded to medication or CBT… who carry decades of painful memories that maintain their depression?

They're the ones who might benefit most from what we do.

It's just a matter of knowing where to look, what to target, and how to adapt the work we already know to address depression's particular fingerprint.

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Until next time,

Chris

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Disclaimer: The information contained in this article is for informational purposes only. This is not legal or clinical advice and we make no guarantees about the outcomes or results from information shared in this document. Proceed at your own risk and discretion.