EMDR (Eye Movement Desensitization and Reprocessing)

The 1989 report on eye movement desensitization

The therapy is associated with Francine Shapiro, who in 1989 published a paper titled 'Eye movement desensitization: a new treatment for post-traumatic stress disorder' in the Journal of Behavior Therapy and Experimental Psychiatry, with an affiliation to the Mental Research Institute in Palo Alto, California. The abstract describes clients producing sequences of large, rhythmic saccadic eye movements while holding in mind the most salient aspect of a traumatic memory. The paper is indexed as a case report, and the outcomes it describes are the author's own claims. Only the abstract was read for this page.

Placement among psychotherapies

A 2013 World Health Organization (WHO) guideline describes EMDR as a treatment developed in the late 1980s and records a disagreement about classification: proponents of EMDR usually do not regard it as a type of cognitive behavioral therapy (CBT), whereas many CBT proponents do. A 2001 meta-analysis described EMDR as a controversial treatment suggested for post-traumatic stress disorder (PTSD) and other conditions, which indicates that its status was contested well before the WHO guideline.

Later guideline recognition

Guideline bodies took up the therapy in stages that are visible in the sources. WHO included it in its 2013 recommendations, the UK National Institute for Health and Care Excellence (NICE) in its December 2018 guideline NG116, the US Department of Veterans Affairs and Department of Defense (VA/DoD) in a 2023 guideline, and the American Psychological Association (APA) in a guideline approved in February 2025. The wording and strength of each position differ and are set out under Research and Evidence. This page does not cover Shapiro's later publications or the founding dates of EMDR professional bodies, because no source for them was verified.

Name and spelling

EMDR is the abbreviation for eye movement desensitization and reprocessing. UK bodies, including NICE and the EMDR Association UK, spell it 'desensitisation'. The 1989 paper used the shorter name 'eye movement desensitization', which is the earliest name found in the sources reviewed. WHO defines the therapy as based on the idea that negative thoughts, feelings and behaviors result from unprocessed memories, using standardized procedures that combine focus on spontaneous associations to traumatic images, thoughts, emotions and bodily sensations with bilateral stimulation.

Bilateral stimulation and dual attention

The term bilateral stimulation covers the alternating input given while a person attends to a memory. NICE says it is normally eye movements but that taps and tones can be used if preferred or more appropriate, for example for people who are visually impaired. The APA guideline describes the same input as an external bilateral stimulus such as eye movements, sounds or tapping, and uses dual attentional focus for attending to the disturbing material while also focusing on that stimulus. The name of the therapy therefore describes its original and most common form and not every variant in use.

Relation to trauma-focused CBT

WHO states that, unlike CBT with a trauma focus, EMDR does not involve detailed descriptions of the event, direct challenging of beliefs, extended exposure or homework. The APA guideline treats trauma-focused CBT as a broad grouping of therapies with elements such as psychoeducation, cognitive restructuring, and in vivo or imaginal exposure, and lists EMDR as a separate intervention. These are definitions used by guideline authors, and, as noted under History and Origins, researchers have not agreed on whether EMDR is a form of CBT.

Phases and sets

The APA guideline describes EMDR as an eight-phase psychotherapy in which a person attends to emotionally disturbing material in brief sequential doses, called sets, while also focusing on an external bilateral stimulus. Between sets the person is asked what comes to mind and is invited to discuss the traumatic experience and shifting perspectives, and body scans are used to judge the degree of resolution. This is the APA's summary of the format and not a treatment manual.

NICE specifies that EMDR for adults should be delivered in a phased manner. The elements it lists are psychoeducation about reactions to trauma, managing distressing memories and situations, identifying and treating target memories (often visual images), and promoting alternative positive beliefs about the self. Repeated in-session bilateral stimulation is used for specific target memories until they are no longer distressing, and the person is taught self-calming techniques and techniques for managing flashbacks, for use within and between sessions.

Length and the practitioner's role

NICE says EMDR for adults should be based on a validated manual and typically be provided over 8 to 12 sessions, with more if clinically indicated, for example when a person has experienced multiple traumas. It also says practitioners should be trained and receive ongoing supervision. WHO adds that EMDR and trauma-focused CBT should be offered only where individuals are trained and supervised to provide them. Session length, setting and fees are not stated in the sources reviewed.

Training and professional bodies

The EMDR Association UK says that EMDR is an advanced psychotherapy and that a mental health clinical background is an essential prerequisite for training. Its entry criteria, set by EMDR Europe, include a significant share of the applicant's role delivering one-to-one psychotherapy, access to training cases and the support of a clinical supervisor. Eligible professions listed include clinical and counselling psychologists registered with the Health and Care Professions Council, psychiatrists, and registered mental health nurses with at least two years of one-to-one psychotherapy experience. Counselors and psychotherapists must hold full accreditation from a listed professional body.

Training providers must be accredited with EMDR Europe, and the association states that training with an unaccredited trainer rules out membership and accreditation. These are a professional body's own standards. Requirements in other countries, including the United States, and any statutory registration were not verified for this page.

Post-traumatic stress disorder

The uses that guidelines address are specific. WHO's recommendations concern PTSD in adults and in children and adolescents, NICE's recommendations concern adults, children and young people with a diagnosis of PTSD or clinically important symptoms of PTSD, and the APA guideline concerns adults with PTSD. The statements in these documents apply to the populations and trauma types they name, and they do not establish uses for other conditions.

Statements by a professional body

The EMDR Association UK describes EMDR as best known for treating PTSD and says it can also help with a range of mental health conditions in people of all ages. The same page says that WHO recognizes EMDR as an effective treatment for children. The WHO guideline reviewed here is worded more narrowly: it says EMDR should be considered for children and adolescents with PTSD and rates the quality of the supporting evidence as low. The association's page is a professional body's description and not an independent assessment of effect.

Uses studied beyond PTSD

Researchers have studied EMDR for other problems. A 2020 meta-analysis of 76 trials reported significant results for phobias and test anxiety, but with few studies and a high risk of bias, and it found too few studies for other mental health problems to pool. A 2025 systematic review of four randomized trials examined EMDR in people with psychosis and co-occurring PTSD. These are studied uses and not established ones, and the findings are described under Research and Evidence and Safety and Suitability.

WHO and NICE positions

WHO's 2013 recommendation 14 says that individual or group CBT with a trauma focus, EMDR or stress management should be considered for adults with PTSD, with strength of recommendation standard and moderate-quality evidence for individual CBT and EMDR. Recommendation 15 says CBT with a trauma focus or EMDR should be considered for children and adolescents, with low-quality evidence for EMDR. WHO noted a lack of consensus between guidelines.

NICE guideline NG116, published 5 December 2018, says to offer EMDR to adults with PTSD or clinically important symptoms who present more than 3 months after a non-combat-related trauma, and to consider it between 1 and 3 months after such a trauma if the person prefers it. For young people aged 7 to 17 presenting more than 3 months after a trauma, NICE says to offer individual trauma-focused CBT and to consider EMDR only if they do not respond to or engage with it.

US guideline positions

The 2023 VA/DoD guideline, as summarized by the VA, recommends three individual manualized trauma-focused psychotherapies for PTSD: cognitive processing therapy, EMDR and prolonged exposure. It states a preference for psychotherapy over medication when both are available.

The APA guideline approved in February 2025 gives a strong recommendation for cognitive processing therapy, prolonged exposure and trauma-focused CBT, and a conditional recommendation to suggest cognitive therapy, EMDR and narrative exposure therapy, over no intervention or treatment as usual. It found insufficient evidence to recommend for or against EMDR over another active intervention such as exposure alone, relaxation or stabilization treatment.

Systematic reviews for PTSD in adults

A 2013 Cochrane review of psychological therapies for chronic PTSD in adults included 70 studies with 4,761 participants. For clinician-rated PTSD severity, EMDR was more effective than waitlist or usual care (standardized mean difference -1.17, 95% confidence interval -2.04 to -0.30; 6 studies, 183 participants), with no statistically significant difference from trauma-focused CBT or stress management immediately after treatment. The authors rated the evidence for each comparison as very low quality.

A 2020 meta-analysis of 76 randomized trials, 62% of them in PTSD, found an effect of EMDR against control conditions of g = 0.93, with high heterogeneity, indications of publication bias and only four of 27 assessed studies at low risk of bias. EMDR was more effective than other therapies (g = 0.36) but not in the studies at low risk of bias. The authors judged study quality too low for definite conclusions.

Children and adolescents

A 2025 systematic review of EMDR for PTSD in children and adolescents included eight randomized trials with 794 participants. Compared with waitlist or usual care, treatment delivered 3 months or more after the trauma had a large pooled effect (standardized mean difference 1.57), with a very wide credible interval of 0.07 to 3.21. Two trials compared EMDR with trauma-focused CBT and found no significant difference.

The dismantling studies

Dismantling studies ask whether a component of a therapy adds to its effect. A 2001 meta-analysis of 34 studies found that EMDR outperformed no treatment and therapies not using exposure, but found no significant effect against other exposure techniques and no incremental effect of eye movements, and its authors concluded that the eye movements appeared unnecessary. A 2013 meta-analysis of 15 clinical trials and 11 laboratory trials (849 participants) reported a moderate additive effect of eye movements in therapy studies (d = 0.41) and a large effect in laboratory studies (d = 0.74), with treatment fidelity as a moderator.

The APA guideline summarizes the later position. It reports that a 2020 analysis of ten dismantling studies, five of them in PTSD, found no advantage for EMDR over exposure without eye movements, and that this did not replicate the 2013 finding. The guideline concludes that EMDR may be an effective psychotherapy for PTSD, while it remains unclear what the specific mechanism of action is or whether the eye movements are necessary.

Mechanism research

A 2018 systematic review of 87 studies on how EMDR might work grouped them into psychological, psychophysiological and neurobiological models. It reported reasonable empirical support for the working memory hypothesis, in which holding a second task in mind makes a memory less vivid, and for physiological changes associated with successful therapy. Neuroimaging evidence was described as preliminary, and the authors described mechanism research as being in its infancy. A proposed mechanism does not establish a clinical benefit.

Why guideline positions differ

The APA guideline notes that VA/DoD recommends EMDR whereas APA gave it a moderate recommendation, expressed as a suggestion, and describes the evidence for EMDR as coming from multiple studies of varying methodological quality. NICE restricts EMDR for children to those who do not respond to trauma-focused CBT, and WHO rated the child evidence as low quality. The reviews above describe small trials, risk of bias and limited follow-up. The dates, methods and populations of each guideline were not compared in detail here.

Reported harms and dropout

Reporting of harms is limited. The 2013 Cochrane review found some evidence of greater dropout in active treatment groups than in comparison groups across the psychological therapies it covered, and this was not reported for EMDR alone. The APA guideline's rationale notes a greater logistic and emotional burden of completing the recommended and suggested interventions, which include EMDR, relative to waitlist. WHO stated in 2013 that it found no systematic review of the potential negative consequences of EMDR as an early intervention in the first month after a traumatic event.

In a 2025 meta-analysis of 60 trials in youth, eight of them of EMDR, reliable deterioration was seen in 1% of young people receiving psychological therapies for PTSD, compared with 13% in control conditions, and a 50% reduction in PTSD symptoms was estimated in 30% of those given EMDR, 48% given trauma-focused CBT and 20% in control conditions; heterogeneity was high and the rates are imputed. A 2025 review of four randomized trials in people with psychosis and PTSD reported no serious adverse events related to the therapy, but improvements in delusions and hallucinations were mostly not significant. An absence of reports does not show that no events occurred.

Suitability and care boundaries

The sources reviewed do not set out formal contraindications for EMDR, and this page does not infer any. NICE describes preparation within the phased format, including teaching self-calming and flashback-management techniques. The APA guideline states that people should receive detailed information about the techniques to be used and the chance to ask questions. VA/DoD states that psychotherapies should be selected based on providers' prior training and supervision. The guideline recommendations concern PTSD and do not address elective wellness uses. Whether EMDR is suitable for a particular person is a matter for clinical assessment.

EMDR does not replace emergency or crisis care. A person with thoughts of self-harm or suicide, or in acute distress, should contact emergency or crisis services or a doctor, and symptoms that persist after a traumatic event are a reason for assessment by a health professional. This page is educational and is not individual medical advice.