EMDR vs. CBT for Trauma: How They Differ and How to Choose

What the two have in common

It helps to start with the overlap, because it is larger than most people expect. The VA's National Center for PTSD says the talk therapies with the most research support are trauma-focused, meaning the treatment centers on the traumatic event and what it means to you. Both EMDR and trauma-focused cognitive behavioral therapy (CBT) fit that description.

The World Health Organization puts the same two approaches side by side. Its fact sheet on PTSD names CBT with a trauma focus and EMDR as the approaches with the most evidence.

Both ask you to approach something you may have been avoiding, in a safe and supportive setting. Both can bring up discomfort along the way, which the National Center for PTSD describes as usually brief. And both are structured: there is a plan, not open-ended talking.

How trauma-focused CBT works

Trauma-focused CBT is a family of therapies, not a single method. The National Institute of Mental Health (NIMH) explains that CBT for PTSD can include exposure therapy, in which a person gradually and safely faces the trauma by talking about it, writing about it or returning to reminders of it, and cognitive restructuring, which helps a person make sense of the event and think about it realistically, especially where guilt or shame have attached to something that was not their fault.

The National Center for PTSD describes two named therapies that work along these lines. In Prolonged Exposure, you gradually approach trauma-related memories, feelings and situations you have been avoiding. You talk through the details of the event with your therapist and practice facing safe situations between sessions. In Cognitive Processing Therapy, you learn to evaluate and change upsetting thoughts about the trauma, such as a belief that you were to blame or that the world is entirely dangerous. That work uses writing and worksheets, in session and at home.

How EMDR works, briefly

In Eye Movement Desensitization and Reprocessing (EMDR), you hold the upsetting memory in mind, along with the thoughts and body sensations connected to it, while paying attention to a back-and-forth movement or sound. The National Center for PTSD explains that this helps you stay in the present while your brain processes the past, so the memory becomes less distressing. Later in the process, you focus on a more positive belief while holding the memory in mind.

The processing happens mostly inside your own head. You report briefly on what you notice, and your therapist guides the next step.

The differences that matter when choosing

These are the practical differences described by the National Center for PTSD. None of them makes one therapy better. They make one therapy a better fit for a particular person.

• How much you say out loud. In EMDR, in most cases you do not need to talk about the details of the trauma, though you will think about it. In Prolonged Exposure, you describe the event in detail. In Cognitive Processing Therapy, you talk about why the trauma happened and how it changed your thinking, and writing a detailed account is optional.
• Practice between sessions. EMDR does not involve homework. Prolonged Exposure includes practicing avoided activities and listening to recordings of your sessions. Cognitive Processing Therapy includes writing and worksheets, and the more effort that goes into them, the more people tend to benefit.
• Where the work is aimed. EMDR works by processing the memory itself. Prolonged Exposure works by approaching the memories and situations you have been avoiding. Cognitive Processing Therapy works on thoughts and beliefs, including how the trauma affected your sense of safety, trust, control and self-esteem.
• Format. EMDR and Prolonged Exposure are one-on-one. Cognitive Processing Therapy can be individual or in a group.

How a therapist and client choose

The National Center for PTSD is direct about this: there is no one treatment that is right for everyone. Several treatments work, which means you have options, and the choice is one you and your provider make together by weighing benefits, risks and your own preferences.

1. 1Start with what you can picture yourself doingSome people want to say what happened out loud and be heard. Others cannot imagine describing it and are relieved that EMDR does not require that. Either reaction is useful information.
2. 2Be honest about practice between sessionsIf worksheets and practice suit how you learn, CBT-based therapy may feel natural. If your weeks are already stretched thin, say so.
3. 3Notice what troubles you mostIf the hardest part is a belief, such as "it was my fault," tell your therapist. If it is a memory that keeps intruding, tell them that too. It helps them suggest a starting point.
4. 4Ask about trainingAsk which trauma therapies a therapist is trained in and how they decide between them. NIMH advises working with a mental health professional who has experience treating PTSD.
5. 5Remember the choice is not finalIf an approach is not helping, you and your therapist can talk about changing course. That is ordinary, not a failure.

How we can help

A member of our team is certified in EMDR, and members of our team use CBT and TF-CBT. Everyone on the team is trained in trauma-sensitive care. Not every therapist uses every approach, so tell us what you are leaning toward and we will match you accordingly. Our trauma and PTSD therapy page explains more, and if worry and tension are the larger part of what you are living with, see anxiety therapy.

All sessions are by secure video, and clients must be physically in Pennsylvania, West Virginia or Arizona during a session. You can meet our team, check insurance and fees, and book a free 15-minute consultation on our booking page to talk through the options.

Therapy is ongoing care, not emergency care. If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services, and our crisis resources page lists more options. NIMH says plainly that people can get better with treatment. Choosing between two good options is a hopeful place to be.