EMDR Therapy: What It Is and Who It Helps
- What EMDR is: A structured, trauma‑focused psychotherapy using bilateral stimulation (eye movements, taps, or tones) to help reprocess distressing memories. Originated by Francine Shapiro (1989). EMDR is not hypnosis (American Psychological Association, 2023).
- Who benefits: Strongest evidence for adults with PTSD; recommended in major guidelines (APA, VA/DoD, NICE, WHO) (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
- Does it work: RCTs and meta‑analyses show clinically meaningful PTSD symptom reductions, broadly comparable to other first‑line trauma psychotherapies (Department of Veterans Affairs & Department of Defense, 2023; NICE NG116, 2018).
- How many sessions: Often weekly 60–90 minute sessions over ~3 months; complexity and stabilisation needs may extend timelines (Department of Veterans Affairs & Department of Defense, 2023).
- Risks: Temporary distress, vivid dreams, fatigue; stabilise first if severe dissociation, active psychosis, acute suicidality, or unstable medical conditions (APA; VA/DoD; WHO).
- Find a therapist: Verify EMDR basic training and accreditation. Use EMDRIA (global) and EMDRAA (Australia) directories (EMDR International Association, n.d.; EMDR Association Australia, n.d.).
Plain-English definition
Eye Movement Desensitisation and Reprocessing (EMDR) is a structured psychotherapy for trauma‑related distress. During EMDR, the therapist guides bilateral stimulation (e.g., eye movements, alternating taps, or tones) while the person holds aspects of a target memory in mind, helping the brain reprocess and integrate the experience. EMDR was developed by Francine Shapiro and is distinct from hypnosis; clients maintain present-focused awareness and dual attention (American Psychological Association, 2023).
EMDR’s conceptual foundation is the Adaptive Information Processing (AIP) model, which proposes that inadequately processed memories can remain state‑specific and trigger symptoms until integrated with adaptive networks. EMDR seeks to facilitate this integration (Shapiro, 2018; EMDR International Association, n.d.).
What happens in a session: The 8 phases
| Phase | Goal | What the patient experiences | Duration cues |
|---|---|---|---|
| 1) History-taking | Formulation and target selection | Discuss background, symptoms, and identify past memories, triggers, and future templates | Varies; more time for complex presentations |
| 2) Preparation | Stabilisation and readiness | Psychoeducation; coping skills; introduce bilateral stimulation; safety planning | Extended as needed for safety |
| 3) Assessment | Activate target memory | Identify image, negative cognition, emotions, sensations; rate SUDS and VOC | Brief activation; sets baseline |
| 4) Desensitisation | Reduce distress | Attend to the target while receiving BLS; notice emerging associations until SUDS reduces | Multiple sets within sessions |
| 5) Installation | Strengthen adaptive belief | Pair positive cognition (e.g., “I’m safe now”) with BLS until it feels true | Continues until VOC increases |
| 6) Body scan | Clear residual somatic distress | Scan head‑to‑toe; reprocess lingering sensations | Brief; repeat as needed |
| 7) Closure | Return to present stability | Grounding; review coping plans between sessions | End of each session |
| 8) Reevaluation | Check progress & plan next targets | Review symptom changes, triggers, and readiness | Opens subsequent sessions |
Key tools: Subjective Units of Disturbance (SUDS), Validity of Cognition (VOC), PTSD Checklist (PCL‑5).
Adapted from APA’s plain‑language EMDR overview and training materials (American Psychological Association, 2023).
How might it work? (AIP vs working‑memory taxation)
AIP model: EMDR reactivates memory networks under safe, dual‑attention conditions so that previously isolated, state‑specific information can connect with adaptive memory networks. This may reduce distress and shift appraisals (Shapiro, 2018; EMDR International Association, n.d.).
Working‑memory taxation: Performing bilateral tasks (e.g., guided eye movements) while recalling vivid images may reduce their emotional intensity and vividness by taxing limited working memory resources. Laboratory studies show reductions in image vividness/unpleasantness under dual‑task conditions (e.g., Behaviour Research and Therapy studies summarised in EMDRIA’s research library). While mechanisms remain debated, guidelines recommend EMDR based on outcome evidence rather than a single definitive mechanism (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018).
What the evidence says
PTSD: EMDR is one of several first‑line trauma‑focused psychotherapies with robust randomised controlled trials and meta‑analyses demonstrating significant symptom reductions across diverse populations. Major guideline bodies include EMDR among recommended treatments for adult PTSD (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
Comparative effectiveness: Across clinical services, EMDR outcomes are broadly comparable to trauma‑focused CBT variants and Prolonged Exposure, with differences influenced by setting, population, adherence, and drop‑out. Real‑world service evaluations (e.g., NHS Talking Therapies) have reported similar recovery rates between EMDR and CT‑PTSD; effects are sensitive to case mix and delivery quality (Belli et al., 2025). Effect sizes vary across reviews due to heterogeneity in trauma type, comorbidities, and comparators.
Other conditions: Emerging evidence exists for some presentations (e.g., complicated grief, pain), but guideline recommendations focus on PTSD. For non‑PTSD uses, proceed cautiously within competence and informed consent. No high‑quality source found for strong non‑PTSD recommendations.
- Session length: Typically 60–90 minutes; often weekly (Department of Veterans Affairs & Department of Defense, 2023).
- Typical course: ~3 months for many cases; longer for complex trauma and stabilisation needs (Department of Veterans Affairs & Department of Defense, 2023).
- Drop‑outs: Ranges vary across modalities and services; completion is influenced by readiness, support, and practical barriers (NICE; service evaluations). No single benchmark applies.
- Outcomes: EMDR vs TF‑CBT often shows comparable PTSD symptom reduction; head‑to‑head differences are modest and context‑dependent (National Institute for Health and Care Excellence, 2018; Belli et al., 2025).
What major guidelines recommend
APA PTSD guideline (2017/updated resources): The APA’s PTSD treatment guideline and topic materials include EMDR among evidence‑based trauma‑focused psychotherapies for adults, with accessible summaries of phases and clinical considerations (American Psychological Association, 2023).
VA/DoD PTSD (2023): The 2023 VA/DoD guideline and National Center for PTSD materials describe EMDR as an effective, trauma‑focused treatment typically delivered weekly over approximately 3 months, with strong recommendations in clinical pathways (Department of Veterans Affairs & Department of Defense, 2023).
NICE NG116 (2018): NICE NG116 lists EMDR as a recommended intervention for PTSD within stepped care and pathway guidance, alongside trauma‑focused CBT and PE (National Institute for Health and Care Excellence, 2018).
WHO mhGAP (2013; updates 2023): WHO guidance for stress‑related conditions recognises EMDR among effective trauma‑focused interventions in humanitarian and general health contexts (World Health Organization, 2013/2023).
Benefits, risks, and contraindications
Benefits: Evidence‑based reductions in PTSD symptoms; often does not require prolonged detailed trauma narration; adaptable to in‑person and telehealth when safety plans and protocols are in place (Department of Veterans Affairs & Department of Defense, 2023; American Psychological Association, 2023).
Common side‑effects: Temporary increases in distress, vivid dreams, fatigue, headaches, and surfacing memories; typically self‑limited with appropriate pacing and stabilisation. Plain‑language summaries by clinical centres (e.g., NHS/Cleveland Clinic) note these effects and recommend preparation and coping support (NHS, n.d.; Cleveland Clinic, n.d.).
Contraindications/cautions: Severe dissociation (phase‑oriented stabilisation required), active psychosis, acute suicidality, unstable cardiac/neurological conditions, and active substance dependence. Coordinate with medical providers and consider phased care; therapist competence and supervision are essential (National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023). Where specific contraindication language is not present in guidelines, consult local clinical protocols.
Who should consider EMDR—and who shouldn’t
- Consider EMDR: Adults with PTSD who prefer less detailed trauma narration, have adequate coping supports, and can engage in regular sessions (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018).
- Stabilise first: Severe dissociation/DID, active psychosis, acute suicidality, active substance misuse, or unstable medical/neurological conditions. Prioritise safety planning, skills, and stepped interventions (World Health Organization, 2013/2023; NICE NG116, 2018).
- Refer/phase‑oriented care: If risk exceeds current stabilisation, use a phase‑based approach and multidisciplinary coordination before reprocessing (APA; WHO).
EMDR vs Trauma‑Focused CBT and Prolonged Exposure
| Therapy | Core method | Trauma narration | Homework load | Evidence summary |
|---|---|---|---|---|
| EMDR | Bilateral stimulation + dual attention reprocessing | Usually brief; not detailed | Lower; coping practice and monitoring | Guideline‑recommended; outcomes often comparable to TF‑CBT/PE |
| TF‑CBT (CT‑PTSD) | Cognitive restructuring + trauma processing | Structured; variable detail | Moderate; cognitive and behavioural tasks | Guideline‑recommended; comparable outcomes to EMDR |
| Prolonged Exposure (PE) | Imaginal + in vivo exposure | Detailed, repeated narration | Higher; recordings + graded exposure | Guideline‑recommended; often equivalent outcomes to EMDR |
Comparisons based on guideline syntheses and service evaluations (National Institute for Health and Care Excellence, 2018; Belli et al., 2025).
| Head‑to‑head highlight | EMDR | TF‑CBT | PE |
|---|---|---|---|
| Typical narration demand | Lower | Moderate | Higher |
What to expect: session count, pacing, homework, after‑effects
Session count & pacing: Many courses involve weekly 60–90 minute sessions over ~3 months, with longer timelines for complex trauma or extensive stabilisation (Department of Veterans Affairs & Department of Defense, 2023).
Homework: EMDR typically emphasises coping practice and monitoring (e.g., grounding, sleep hygiene, journaling). Less reliance on recorded imaginal exposures than PE (National Institute for Health and Care Excellence, 2018).
After‑effects: Temporary increases in dream intensity, emotional lability, or fatigue are common. Plan rest and self‑care; communicate with your therapist if symptoms spike (NHS; Cleveland Clinic, n.d.).
In‑person vs telehealth: EMDR can be adapted online using safe bilateral stimulation methods (visual tracking, taps, tones) with clear risk protocols and emergency planning (Department of Veterans Affairs & Department of Defense, 2023).
Finding a qualified therapist
Training & accreditation: Verify completion of EMDR basic training and consultation hours. In Australia, check EMDRAA‑approved training and accreditation status; internationally, check EMDRIA membership and credentialing (EMDR Association Australia, n.d.; EMDR International Association, n.d.).
- Verification steps: Ask for proof of EMDR basic training, consultation/supervision, and current accreditation or membership (EMDRIA/EMDRAA).
- Directories: Use EMDRIA’s global directory and EMDRAA’s “Find a Therapist” for Australia.
- Competence questions: Query experience with complex trauma/dissociation, safety planning, and adherence to guidelines.
Costs and coverage
Australia (Medicare Better Access): With a GP Mental Health Treatment Plan and referral, Medicare rebates are available for eligible psychology services under Better Access, with annual session caps and specific item/referral requirements detailed in MBS explanatory notes. See official factsheets and item descriptors for current rules (Department of Health and Aged Care, 2025; Medicare Benefits Schedule, n.d.).
Private health: Some extras policies cover psychology; amounts and limits vary by fund/policy. Check the insurer’s product disclosure statement. No high‑quality source found.
Global overview: Coverage depends on national health systems and insurers. Confirm recognition of EMDR providers via EMDRIA or local associations.
Myths, debates, and open questions
- EMDR ≠ hypnosis: EMDR uses dual attention and present anchors, not trance induction (American Psychological Association, 2023).
- Mechanism debate: AIP vs working‑memory taxation; recommendations are grounded in outcomes, not a single mechanism (National Institute for Health and Care Excellence, 2018; Department of Veterans Affairs & Department of Defense, 2023).
- Eye movements vs other BLS: Non‑visual BLS (taps/tones) is common; necessity of eye movements is under study. Guidelines focus on protocol fidelity rather than mandating a single BLS type (APA; VA/DoD).
- Beyond PTSD: Evidence is heterogeneous; use caution and informed consent for off‑label applications. No high‑quality source found for strong non‑PTSD recommendations.
Bottom line & next steps
EMDR is a guideline‑recommended, trauma‑focused psychotherapy with strong evidence for PTSD, generally comparable outcomes to other first‑line options, and a structured eight‑phase protocol. If considering EMDR, verify therapist training (EMDRIA/EMDRAA), assess readiness and stabilisation needs, and discuss session pacing and after‑effects. For Australian readers, explore Medicare Better Access rebates via official MBS resources and EMDRAA’s therapist finder.
Evidence table
| Claim | Best evidence | Source | Year | Quality | Notes |
|---|---|---|---|---|---|
| EMDR is effective for adult PTSD | Guideline recommendations + RCT/meta‑analyses | VA/DoD PTSD guideline portal | 2023 | High | Describes weekly delivery over ~3 months and strong evidence |
| EMDR outcomes comparable to TF‑CBT | Real‑world service evaluation | NHS Talking Therapies (Belli et al.) | 2025 | Moderate | Similar recovery rates; context‑dependent |
| Typical course ~3 months | Guideline portal description | VA/DoD National Center for PTSD | 2023 | High | Weekly 60–90 minutes for ~3 months |
| Side‑effects: vivid dreams, fatigue | Clinical centre explainers | NHS; Cleveland Clinic | n.d. | Moderate | Plain‑language risk overviews |
| EMDR recommended in major guidelines | Guideline listings (APA, NICE, WHO) | APA; NICE NG116; WHO mhGAP | 2013–2025 | High | Multiple bodies include EMDR |
FAQ
- What is EMDR and how is it different from CBT? EMDR uses bilateral stimulation during memory recall to facilitate reprocessing, often with less detailed narration than CBT or PE. CBT variants rely on cognitive restructuring and exposure (American Psychological Association, 2023; National Institute for Health and Care Excellence, 2018).
- Does EMDR work for PTSD? How strong is the evidence? Yes. EMDR is included in major guidelines (APA, VA/DoD, NICE, WHO) as a recommended trauma‑focused treatment for adult PTSD, supported by RCTs and meta‑analyses (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
- How many sessions does EMDR usually take? Many courses run weekly 60–90 minute sessions over ~3 months; timelines vary by complexity and stabilisation needs (Department of Veterans Affairs & Department of Defense, 2023).
- What happens during an EMDR session? Will I have to describe my trauma in detail? You identify target images/cognitions and receive bilateral stimulation while focusing on the memory. Many protocols do not require detailed narration (American Psychological Association, 2023).
- Are eye movements necessary (versus tappers/tones)? Bilateral stimulation can be eye movements, taps, or tones. The specific necessity of eye movements is debated; non‑visual BLS is widely used (American Psychological Association, 2023; Department of Veterans Affairs & Department of Defense, 2023).
- What are the risks or side‑effects? Can EMDR make symptoms worse before they improve? Temporary distress, vivid dreams, fatigue, and surfacing memories are possible; pacing and stabilisation reduce risks. Some feel worse before better (NHS; Cleveland Clinic, n.d.).
- Who should not do EMDR (or should stabilise first)? Severe dissociation, active psychosis, acute suicidality, unstable medical/neurological conditions, and active substance misuse warrant stabilisation first (National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
- Is EMDR effective for complex PTSD, dissociation, or psychosis? Evidence is mixed; use phase‑oriented approaches and careful stabilisation. No high‑quality source found for strong recommendations beyond PTSD.
- Can EMDR be done online? Yes, with secure platforms and adapted BLS (visual tracking, taps, tones) plus risk protocols (Department of Veterans Affairs & Department of Defense, 2023).
- Is EMDR safe/effective for children or teens? EMDR is used with youth, but recommendations vary by age/setting; seek specialist training. Consult local guidance. No high‑quality source found.
- EMDR vs Prolonged Exposure vs TF‑CBT—how do results compare? Outcomes are often comparable; choice depends on preference, tolerability, and context (National Institute for Health and Care Excellence, 2018; Belli et al., 2025).
- How do I find a qualified therapist (certifications/accreditations)? Use EMDRIA (global) and EMDRAA (Australia). Verify basic training, consultation, and current accreditation/membership (EMDR International Association, n.d.; EMDR Association Australia, n.d.).
- Is EMDR covered by insurance/Medicare (AU)? How do rebates work? Under Better Access, Medicare rebates apply for eligible psychology services with GP plan/referral; session caps and item rules apply. See MBS notes (Department of Health and Aged Care, 2025; Medicare Benefits Schedule, n.d.).
- How should I prepare for my first session, and what might I feel afterwards? Build coping skills (grounding, breathing), plan rest, and expect possible temporary distress or vivid dreams; keep your therapist informed (NHS; Cleveland Clinic, n.d.).
How we verified this page
We prioritised clinical practice guidelines and systematic secondary sources (APA topic materials; VA/DoD 2023 PTSD guideline portal; NICE NG116 2018; WHO mhGAP stress guidance), then cross‑checked patient‑facing explainers (NHS; Cleveland Clinic) for plain‑language clarity. Where a specific claim lacked a verifiable high‑quality source, we indicated “No high‑quality source found.”
References (APA‑7)
American Psychological Association. (2023, November 20). Exploring the 8 phases of EMDR. https://www.apa.org/topics/psychotherapy/emdr-phases
Belli, S. R., Howell, M., Grey, N., Tiraboschi, S., & Sim, A. (2025). Evaluating the effectiveness of tfCBT and EMDR interventions for PTSD in an NHS Talking Therapies service. The Cognitive Behaviour Therapist, 18, e6. https://doi.org/10.1017/S1754470X24000497
Cleveland Clinic. (n.d.). EMDR therapy. https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy
Department of Health and Aged Care. (2025, October 1). Better Access changes from 1 November 2025. https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Better%20Access%20changes%20from%201%20November%202025
Department of Veterans Affairs & Department of Defense. (2023). Eye Movement Desensitization and Reprocessing (EMDR) for PTSD (National Center for PTSD). https://www.ptsd.va.gov/professional/treat/txessentials/emdr_pro.asp
EMDR Association Australia (EMDRAA). (n.d.). Find a therapist. https://emdraa.org/find-a-therapist/
EMDR International Association (EMDRIA). (n.d.). About EMDR therapy & AIP model. https://www.emdria.org/about-emdr-therapy/aip-model/
Medicare Benefits Schedule. (n.d.). Explanatory notes & item descriptors (e.g., 80170). https://www9.health.gov.au/mbs/
National Institute for Health and Care Excellence. (2018). Post‑traumatic stress disorder: NICE guideline [NG116]. https://www.nice.org.uk/guidance/ng116
NHS. (n.d.). EMDR therapy overview for patients. https://www.nhs.uk/mental-health/talking-therapies-and-counselling/types-of-talking-therapies/emdr-therapy/
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
World Health Organization. (2013). mhGAP intervention guide (Version 2.0) & stress‑related conditions. https://www.who.int/publications/i/item/9789241549790
World Health Organization. (2023). Guidelines on mental health interventions for adults affected by humanitarian emergencies. https://www.who.int
This page is educational and not medical advice. If you are in immediate danger, call 000 (Australia) or your local emergency number. For crisis support, contact Lifeline at 13 11 14.
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Book an AppointmentEMDR Therapy: What It Is and Who It Helps
- What EMDR is: A structured, trauma‑focused psychotherapy using bilateral stimulation (eye movements, taps, or tones) to help reprocess distressing memories. Originated by Francine Shapiro (1989). EMDR is not hypnosis (American Psychological Association, 2023).
- Who benefits: Strongest evidence for adults with PTSD; recommended in major guidelines (APA, VA/DoD, NICE, WHO) (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
- Does it work: RCTs and meta‑analyses show clinically meaningful PTSD symptom reductions, broadly comparable to other first‑line trauma psychotherapies (Department of Veterans Affairs & Department of Defense, 2023; NICE NG116, 2018).
- How many sessions: Often weekly 60–90 minute sessions over ~3 months; complexity and stabilisation needs may extend timelines (Department of Veterans Affairs & Department of Defense, 2023).
- Risks: Temporary distress, vivid dreams, fatigue; stabilise first if severe dissociation, active psychosis, acute suicidality, or unstable medical conditions (APA; VA/DoD; WHO).
- Find a therapist: Verify EMDR basic training and accreditation. Use EMDRIA (global) and EMDRAA (Australia) directories (EMDR International Association, n.d.; EMDR Association Australia, n.d.).
Plain-English definition
Eye Movement Desensitisation and Reprocessing (EMDR) is a structured psychotherapy for trauma‑related distress. During EMDR, the therapist guides bilateral stimulation (e.g., eye movements, alternating taps, or tones) while the person holds aspects of a target memory in mind, helping the brain reprocess and integrate the experience. EMDR was developed by Francine Shapiro and is distinct from hypnosis; clients maintain present-focused awareness and dual attention (American Psychological Association, 2023).
EMDR’s conceptual foundation is the Adaptive Information Processing (AIP) model, which proposes that inadequately processed memories can remain state‑specific and trigger symptoms until integrated with adaptive networks. EMDR seeks to facilitate this integration (Shapiro, 2018; EMDR International Association, n.d.).
What happens in a session: The 8 phases
| Phase | Goal | What the patient experiences | Duration cues |
|---|---|---|---|
| 1) History-taking | Formulation and target selection | Discuss background, symptoms, and identify past memories, triggers, and future templates | Varies; more time for complex presentations |
| 2) Preparation | Stabilisation and readiness | Psychoeducation; coping skills; introduce bilateral stimulation; safety planning | Extended as needed for safety |
| 3) Assessment | Activate target memory | Identify image, negative cognition, emotions, sensations; rate SUDS and VOC | Brief activation; sets baseline |
| 4) Desensitisation | Reduce distress | Attend to the target while receiving BLS; notice emerging associations until SUDS reduces | Multiple sets within sessions |
| 5) Installation | Strengthen adaptive belief | Pair positive cognition (e.g., “I’m safe now”) with BLS until it feels true | Continues until VOC increases |
| 6) Body scan | Clear residual somatic distress | Scan head‑to‑toe; reprocess lingering sensations | Brief; repeat as needed |
| 7) Closure | Return to present stability | Grounding; review coping plans between sessions | End of each session |
| 8) Reevaluation | Check progress & plan next targets | Review symptom changes, triggers, and readiness | Opens subsequent sessions |
Key tools: Subjective Units of Disturbance (SUDS), Validity of Cognition (VOC), PTSD Checklist (PCL‑5).
Adapted from APA’s plain‑language EMDR overview and training materials (American Psychological Association, 2023).
How might it work? (AIP vs working‑memory taxation)
AIP model: EMDR reactivates memory networks under safe, dual‑attention conditions so that previously isolated, state‑specific information can connect with adaptive memory networks. This may reduce distress and shift appraisals (Shapiro, 2018; EMDR International Association, n.d.).
Working‑memory taxation: Performing bilateral tasks (e.g., guided eye movements) while recalling vivid images may reduce their emotional intensity and vividness by taxing limited working memory resources. Laboratory studies show reductions in image vividness/unpleasantness under dual‑task conditions (e.g., Behaviour Research and Therapy studies summarised in EMDRIA’s research library). While mechanisms remain debated, guidelines recommend EMDR based on outcome evidence rather than a single definitive mechanism (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018).
What the evidence says
PTSD: EMDR is one of several first‑line trauma‑focused psychotherapies with robust randomised controlled trials and meta‑analyses demonstrating significant symptom reductions across diverse populations. Major guideline bodies include EMDR among recommended treatments for adult PTSD (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
Comparative effectiveness: Across clinical services, EMDR outcomes are broadly comparable to trauma‑focused CBT variants and Prolonged Exposure, with differences influenced by setting, population, adherence, and drop‑out. Real‑world service evaluations (e.g., NHS Talking Therapies) have reported similar recovery rates between EMDR and CT‑PTSD; effects are sensitive to case mix and delivery quality (Belli et al., 2025). Effect sizes vary across reviews due to heterogeneity in trauma type, comorbidities, and comparators.
Other conditions: Emerging evidence exists for some presentations (e.g., complicated grief, pain), but guideline recommendations focus on PTSD. For non‑PTSD uses, proceed cautiously within competence and informed consent. No high‑quality source found for strong non‑PTSD recommendations.
- Session length: Typically 60–90 minutes; often weekly (Department of Veterans Affairs & Department of Defense, 2023).
- Typical course: ~3 months for many cases; longer for complex trauma and stabilisation needs (Department of Veterans Affairs & Department of Defense, 2023).
- Drop‑outs: Ranges vary across modalities and services; completion is influenced by readiness, support, and practical barriers (NICE; service evaluations). No single benchmark applies.
- Outcomes: EMDR vs TF‑CBT often shows comparable PTSD symptom reduction; head‑to‑head differences are modest and context‑dependent (National Institute for Health and Care Excellence, 2018; Belli et al., 2025).
What major guidelines recommend
APA PTSD guideline (2017/updated resources): The APA’s PTSD treatment guideline and topic materials include EMDR among evidence‑based trauma‑focused psychotherapies for adults, with accessible summaries of phases and clinical considerations (American Psychological Association, 2023).
VA/DoD PTSD (2023): The 2023 VA/DoD guideline and National Center for PTSD materials describe EMDR as an effective, trauma‑focused treatment typically delivered weekly over approximately 3 months, with strong recommendations in clinical pathways (Department of Veterans Affairs & Department of Defense, 2023).
NICE NG116 (2018): NICE NG116 lists EMDR as a recommended intervention for PTSD within stepped care and pathway guidance, alongside trauma‑focused CBT and PE (National Institute for Health and Care Excellence, 2018).
WHO mhGAP (2013; updates 2023): WHO guidance for stress‑related conditions recognises EMDR among effective trauma‑focused interventions in humanitarian and general health contexts (World Health Organization, 2013/2023).
Benefits, risks, and contraindications
Benefits: Evidence‑based reductions in PTSD symptoms; often does not require prolonged detailed trauma narration; adaptable to in‑person and telehealth when safety plans and protocols are in place (Department of Veterans Affairs & Department of Defense, 2023; American Psychological Association, 2023).
Common side‑effects: Temporary increases in distress, vivid dreams, fatigue, headaches, and surfacing memories; typically self‑limited with appropriate pacing and stabilisation. Plain‑language summaries by clinical centres (e.g., NHS/Cleveland Clinic) note these effects and recommend preparation and coping support (NHS, n.d.; Cleveland Clinic, n.d.).
Contraindications/cautions: Severe dissociation (phase‑oriented stabilisation required), active psychosis, acute suicidality, unstable cardiac/neurological conditions, and active substance dependence. Coordinate with medical providers and consider phased care; therapist competence and supervision are essential (National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023). Where specific contraindication language is not present in guidelines, consult local clinical protocols.
Who should consider EMDR—and who shouldn’t
- Consider EMDR: Adults with PTSD who prefer less detailed trauma narration, have adequate coping supports, and can engage in regular sessions (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018).
- Stabilise first: Severe dissociation/DID, active psychosis, acute suicidality, active substance misuse, or unstable medical/neurological conditions. Prioritise safety planning, skills, and stepped interventions (World Health Organization, 2013/2023; NICE NG116, 2018).
- Refer/phase‑oriented care: If risk exceeds current stabilisation, use a phase‑based approach and multidisciplinary coordination before reprocessing (APA; WHO).
EMDR vs Trauma‑Focused CBT and Prolonged Exposure
| Therapy | Core method | Trauma narration | Homework load | Evidence summary |
|---|---|---|---|---|
| EMDR | Bilateral stimulation + dual attention reprocessing | Usually brief; not detailed | Lower; coping practice and monitoring | Guideline‑recommended; outcomes often comparable to TF‑CBT/PE |
| TF‑CBT (CT‑PTSD) | Cognitive restructuring + trauma processing | Structured; variable detail | Moderate; cognitive and behavioural tasks | Guideline‑recommended; comparable outcomes to EMDR |
| Prolonged Exposure (PE) | Imaginal + in vivo exposure | Detailed, repeated narration | Higher; recordings + graded exposure | Guideline‑recommended; often equivalent outcomes to EMDR |
Comparisons based on guideline syntheses and service evaluations (National Institute for Health and Care Excellence, 2018; Belli et al., 2025).
| Head‑to‑head highlight | EMDR | TF‑CBT | PE |
|---|---|---|---|
| Typical narration demand | Lower | Moderate | Higher |
What to expect: session count, pacing, homework, after‑effects
Session count & pacing: Many courses involve weekly 60–90 minute sessions over ~3 months, with longer timelines for complex trauma or extensive stabilisation (Department of Veterans Affairs & Department of Defense, 2023).
Homework: EMDR typically emphasises coping practice and monitoring (e.g., grounding, sleep hygiene, journaling). Less reliance on recorded imaginal exposures than PE (National Institute for Health and Care Excellence, 2018).
After‑effects: Temporary increases in dream intensity, emotional lability, or fatigue are common. Plan rest and self‑care; communicate with your therapist if symptoms spike (NHS; Cleveland Clinic, n.d.).
In‑person vs telehealth: EMDR can be adapted online using safe bilateral stimulation methods (visual tracking, taps, tones) with clear risk protocols and emergency planning (Department of Veterans Affairs & Department of Defense, 2023).
Finding a qualified therapist
Training & accreditation: Verify completion of EMDR basic training and consultation hours. In Australia, check EMDRAA‑approved training and accreditation status; internationally, check EMDRIA membership and credentialing (EMDR Association Australia, n.d.; EMDR International Association, n.d.).
- Verification steps: Ask for proof of EMDR basic training, consultation/supervision, and current accreditation or membership (EMDRIA/EMDRAA).
- Directories: Use EMDRIA’s global directory and EMDRAA’s “Find a Therapist” for Australia.
- Competence questions: Query experience with complex trauma/dissociation, safety planning, and adherence to guidelines.
Costs and coverage
Australia (Medicare Better Access): With a GP Mental Health Treatment Plan and referral, Medicare rebates are available for eligible psychology services under Better Access, with annual session caps and specific item/referral requirements detailed in MBS explanatory notes. See official factsheets and item descriptors for current rules (Department of Health and Aged Care, 2025; Medicare Benefits Schedule, n.d.).
Private health: Some extras policies cover psychology; amounts and limits vary by fund/policy. Check the insurer’s product disclosure statement. No high‑quality source found.
Global overview: Coverage depends on national health systems and insurers. Confirm recognition of EMDR providers via EMDRIA or local associations.
Myths, debates, and open questions
- EMDR ≠ hypnosis: EMDR uses dual attention and present anchors, not trance induction (American Psychological Association, 2023).
- Mechanism debate: AIP vs working‑memory taxation; recommendations are grounded in outcomes, not a single mechanism (National Institute for Health and Care Excellence, 2018; Department of Veterans Affairs & Department of Defense, 2023).
- Eye movements vs other BLS: Non‑visual BLS (taps/tones) is common; necessity of eye movements is under study. Guidelines focus on protocol fidelity rather than mandating a single BLS type (APA; VA/DoD).
- Beyond PTSD: Evidence is heterogeneous; use caution and informed consent for off‑label applications. No high‑quality source found for strong non‑PTSD recommendations.
Bottom line & next steps
EMDR is a guideline‑recommended, trauma‑focused psychotherapy with strong evidence for PTSD, generally comparable outcomes to other first‑line options, and a structured eight‑phase protocol. If considering EMDR, verify therapist training (EMDRIA/EMDRAA), assess readiness and stabilisation needs, and discuss session pacing and after‑effects. For Australian readers, explore Medicare Better Access rebates via official MBS resources and EMDRAA’s therapist finder.
Evidence table
| Claim | Best evidence | Source | Year | Quality | Notes |
|---|---|---|---|---|---|
| EMDR is effective for adult PTSD | Guideline recommendations + RCT/meta‑analyses | VA/DoD PTSD guideline portal | 2023 | High | Describes weekly delivery over ~3 months and strong evidence |
| EMDR outcomes comparable to TF‑CBT | Real‑world service evaluation | NHS Talking Therapies (Belli et al.) | 2025 | Moderate | Similar recovery rates; context‑dependent |
| Typical course ~3 months | Guideline portal description | VA/DoD National Center for PTSD | 2023 | High | Weekly 60–90 minutes for ~3 months |
| Side‑effects: vivid dreams, fatigue | Clinical centre explainers | NHS; Cleveland Clinic | n.d. | Moderate | Plain‑language risk overviews |
| EMDR recommended in major guidelines | Guideline listings (APA, NICE, WHO) | APA; NICE NG116; WHO mhGAP | 2013–2025 | High | Multiple bodies include EMDR |
FAQ
- What is EMDR and how is it different from CBT? EMDR uses bilateral stimulation during memory recall to facilitate reprocessing, often with less detailed narration than CBT or PE. CBT variants rely on cognitive restructuring and exposure (American Psychological Association, 2023; National Institute for Health and Care Excellence, 2018).
- Does EMDR work for PTSD? How strong is the evidence? Yes. EMDR is included in major guidelines (APA, VA/DoD, NICE, WHO) as a recommended trauma‑focused treatment for adult PTSD, supported by RCTs and meta‑analyses (Department of Veterans Affairs & Department of Defense, 2023; National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
- How many sessions does EMDR usually take? Many courses run weekly 60–90 minute sessions over ~3 months; timelines vary by complexity and stabilisation needs (Department of Veterans Affairs & Department of Defense, 2023).
- What happens during an EMDR session? Will I have to describe my trauma in detail? You identify target images/cognitions and receive bilateral stimulation while focusing on the memory. Many protocols do not require detailed narration (American Psychological Association, 2023).
- Are eye movements necessary (versus tappers/tones)? Bilateral stimulation can be eye movements, taps, or tones. The specific necessity of eye movements is debated; non‑visual BLS is widely used (American Psychological Association, 2023; Department of Veterans Affairs & Department of Defense, 2023).
- What are the risks or side‑effects? Can EMDR make symptoms worse before they improve? Temporary distress, vivid dreams, fatigue, and surfacing memories are possible; pacing and stabilisation reduce risks. Some feel worse before better (NHS; Cleveland Clinic, n.d.).
- Who should not do EMDR (or should stabilise first)? Severe dissociation, active psychosis, acute suicidality, unstable medical/neurological conditions, and active substance misuse warrant stabilisation first (National Institute for Health and Care Excellence, 2018; World Health Organization, 2013/2023).
- Is EMDR effective for complex PTSD, dissociation, or psychosis? Evidence is mixed; use phase‑oriented approaches and careful stabilisation. No high‑quality source found for strong recommendations beyond PTSD.
- Can EMDR be done online? Yes, with secure platforms and adapted BLS (visual tracking, taps, tones) plus risk protocols (Department of Veterans Affairs & Department of Defense, 2023).
- Is EMDR safe/effective for children or teens? EMDR is used with youth, but recommendations vary by age/setting; seek specialist training. Consult local guidance. No high‑quality source found.
- EMDR vs Prolonged Exposure vs TF‑CBT—how do results compare? Outcomes are often comparable; choice depends on preference, tolerability, and context (National Institute for Health and Care Excellence, 2018; Belli et al., 2025).
- How do I find a qualified therapist (certifications/accreditations)? Use EMDRIA (global) and EMDRAA (Australia). Verify basic training, consultation, and current accreditation/membership (EMDR International Association, n.d.; EMDR Association Australia, n.d.).
- Is EMDR covered by insurance/Medicare (AU)? How do rebates work? Under Better Access, Medicare rebates apply for eligible psychology services with GP plan/referral; session caps and item rules apply. See MBS notes (Department of Health and Aged Care, 2025; Medicare Benefits Schedule, n.d.).
- How should I prepare for my first session, and what might I feel afterwards? Build coping skills (grounding, breathing), plan rest, and expect possible temporary distress or vivid dreams; keep your therapist informed (NHS; Cleveland Clinic, n.d.).
How we verified this page
We prioritised clinical practice guidelines and systematic secondary sources (APA topic materials; VA/DoD 2023 PTSD guideline portal; NICE NG116 2018; WHO mhGAP stress guidance), then cross‑checked patient‑facing explainers (NHS; Cleveland Clinic) for plain‑language clarity.
References (APA‑7)
American Psychological Association. (2023, November 20). Exploring the 8 phases of EMDR. https://www.apa.org/topics/psychotherapy/emdr-phases
Belli, S. R., Howell, M., Grey, N., Tiraboschi, S., & Sim, A. (2025). Evaluating the effectiveness of tfCBT and EMDR interventions for PTSD in an NHS Talking Therapies service. The Cognitive Behaviour Therapist, 18, e6. https://doi.org/10.1017/S1754470X24000497
Cleveland Clinic. (n.d.). EMDR therapy. https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy
Department of Health and Aged Care. (2025, October 1). Better Access changes from 1 November 2025. https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Better%20Access%20changes%20from%201%20November%202025
Department of Veterans Affairs & Department of Defense. (2023). Eye Movement Desensitization and Reprocessing (EMDR) for PTSD (National Center for PTSD). https://www.ptsd.va.gov/professional/treat/txessentials/emdr_pro.asp
EMDR Association Australia (EMDRAA). (n.d.). Find a therapist. https://emdraa.org/find-a-therapist/
EMDR International Association (EMDRIA). (n.d.). About EMDR therapy & AIP model. https://www.emdria.org/about-emdr-therapy/aip-model/
Medicare Benefits Schedule. (n.d.). Explanatory notes & item descriptors (e.g., 80170). https://www9.health.gov.au/mbs/
National Institute for Health and Care Excellence. (2018). Post‑traumatic stress disorder: NICE guideline [NG116]. https://www.nice.org.uk/guidance/ng116
NHS. (n.d.). EMDR therapy overview for patients. https://www.nhs.uk/mental-health/talking-therapies-and-counselling/types-of-talking-therapies/emdr-therapy/
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
World Health Organization. (2013). mhGAP intervention guide (Version 2.0) & stress‑related conditions. https://www.who.int/publications/i/item/9789241549790
World Health Organization. (2023). Guidelines on mental health interventions for adults affected by humanitarian emergencies. https://www.who.int
This page is educational and not medical advice. If you are in immediate danger, call 000 (Australia) or your local emergency number. For crisis support, contact Lifeline at 13 11 14.
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