EMDR Sounds Like a Gimmick. It’s in the VA’s Own PTSD Guideline.

Key Takeaways

• The 2023 VA/DoD guideline for posttraumatic stress disorder recommends three specific trauma-focused psychotherapies, prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR), and recommends structured psychotherapy over medication.
• A 2020 systematic review of 114 randomized trials involving 8,171 adults found that both trauma-focused cognitive behavioral therapy and EMDR had clinically important effects on PTSD.
• Researchers still disagree about whether the eye movements themselves matter: an earlier meta-analysis found they added nothing measurable, while a 2013 meta-analysis of 26 studies found they added a moderate effect.

Today is Veterans Day, so let me take on the therapy that gets the most raised eyebrows. You sit with a trained therapist, bring a piece of the worst memory of your life to mind for a short stretch, and follow their hand with your eyes as it moves side to side. If that sounds like a party trick, you are in good company. Plenty of veterans assume EMDR for PTSD is a fringe idea, and plenty assume the real treatment for posttraumatic stress is a pill, with therapy as the soft option. Both assumptions are wrong. EMDR, short for eye movement desensitization and reprocessing, is one of only three therapies that the 2023 Department of Veterans Affairs and Department of Defense guideline for PTSD gives its strongest recommendation, alongside prolonged exposure and cognitive processing therapy. And that same guideline recommends these structured trauma therapies over medication, not as a backup to it. For someone who has spent years being told to manage symptoms, that is a very different message: the goal is not just coping with the memory. It is changing how much power the memory still has over you.

The evidence behind that recommendation is broad, though not flawless. A 2020 systematic review pooled 114 randomized trials with 8,171 adults and found robust evidence that trauma-focused cognitive behavioral therapy and EMDR both produced clinically important improvements, which is why the authors called them first-line treatments. A separate 2020 meta-analysis of 76 EMDR trials found a large effect compared with control conditions, and it was honest about the weak spots: only four of 27 studies had a low risk of bias, and EMDR’s apparent edge over other therapies disappeared in the most rigorous ones. So the fairest reading is that EMDR works about as well as the other good trauma therapies, not better. The strangest part is the eye movements themselves. An early meta-analysis found they added nothing measurable. A 2013 meta-analysis of 26 studies disagreed, finding a moderate added effect in treatment trials and a larger one in laboratory studies, where simply moving the eyes while holding a distressing memory made that memory feel less vivid. Researchers are still arguing about why.

Does EMDR for PTSD work, or is it just the eye movements people talk about?

Here is my honest take. I don’t care much whether it’s the eye movements. I care that veterans know there are trauma therapies with real results, and that “just live with it” is not the plan. If one approach doesn’t fit you, there are others with equally solid evidence, and you are allowed to ask for them by name: prolonged exposure, cognitive processing therapy, or EMDR. The same guideline makes two other points I wish more people heard. It recommends against benzodiazepines and against cannabis or cannabis-derived products for PTSD, two of the things people most often reach for on their own. And it supports delivering recommended therapy by secure video when that therapy has been validated for video or when other options are unavailable, so distance does not have to be the barrier. Before you give up on treatment, I’d check one thing: whether you have actually had one of these therapies, delivered by someone trained in it, start to finish. If today is hard, or any day is, the Veterans Crisis Line is open around the clock: dial 988, then press 1. PTSD is treatable. Pass that on to someone who needs to hear it.

References

1. Schnurr, P. P., Hamblen, J. L., Wolf, J., Coller, R., Collie, C., Fuller, M. A., et al. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Annals of Internal Medicine, 177(3), 363-374.
2. Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633.
3. Cuijpers, P., Veen, S. C. V., Sijbrandij, M., Yoder, W., & Cristea, I. A. (2020). Eye movement desensitization and reprocessing for mental health problems: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(3), 165-180.
4. Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231-239.