EMDR in PTSD: Effective but What?

May 31, 2025 Psychotherapy No Comments

EMDR is widely recognized as a treatment for PTSD, but what makes it effective? Is it the method — or something else entirely?

This blog explores the scientific evidence and what it tells us about the deeper nature of therapeutic change, especially in PTSD (post-traumatic stress disorder).

Beyond the eye movements

EMDR – short for Eye Movement Desensitization and Reprocessing – is a treatment designed to reduce the emotional burden of traumatic memories. Its sessions are structured around the reactivation of distressing experiences while the patient follows side-to-side eye movements, hears alternating tones, or receives bilateral tactile stimulation. These movements are often seen as the hallmark of EMDR.

But even supporters admit: the technique’s core mechanism remains a mystery. The method has become something of a star in trauma therapy circles, yet there’s a subtle tension hiding under the surface. If it works, the next question is: why?

A sudden spark: the origin of EMDR

EMDR’s birth was serendipitous. In 1987, Francine Shapiro, a psychology student at the time, noticed her own anxious thoughts fading when she moved her eyes rapidly while walking. Inspired by this personal observation, she crafted a method that would, in time, gain institutional validation across the globe.

By 1989, Shapiro published her first controlled study, and EMDR began its rapid ascent. The original name, Eye Movement Desensitization, later evolved to EMDR to reflect the added component of ‘reprocessing.’ Even so, as Shapiro herself later acknowledged, the method’s name created confusion. She clarified that eye movements are only one form of bilateral stimulation, and that the deeper therapeutic goal lies in changing the meaning of past events [1].

“What is effective in EMDR is not new, and what is new is not effective.”

That sentence – quoted directly from a major meta-analysis [2] – captures much of the concern. Another large study, based on individual participant data, confirms this pattern. It concludes: “There was no evidence that EMDR was more effective than other psychological treatments” [3].

Numerous studies, including dismantling trials, show that removing the eye movement component doesn’t reduce EMDR’s therapeutic power. Other dual tasks, such as mental arithmetic or even playing Tetris, yield similar results. [4]. What’s more, the emotional reduction often comes fast – sometimes within one session – a pace that invites suspicion.

[4] examines this in depth, showing that the core of EMDR may rely on working memory taxation. When attention is split between remembering a traumatic event and doing a distracting task (like tracking moving dots), the memory loses some of its emotional punch. Yet this ‘punching-down’ appears not to be unique to EMDR. It’s more like a general cognitive effect — perhaps useful, but not profound.

That makes all the difference. If EMDR mainly distracts or obscures pain through a symbolic structure, its effectiveness may be more about suppression than integration.

The power of ritual and expectation

EMDR is undeniably effective — across multiple studies and populations, including war survivors, victims of sexual assault, and individuals facing complex trauma. But what if the reason it works is not in the method itself, but in how it is received?

One review [5] affirms that EMDR reduces symptoms of PTSD, but also notes: “The quality of the evidence is heterogeneous.” Even when compared to Prolonged Exposure or Cognitive Behavioral Therapy, no consistent advantage emerges [6], [7]. As Rothbaum et al. conclude: “PE and EMDR did not differ significantly at posttreatment or follow-up.” [7]

And then there’s context. A study on refugees and asylum seekers reports: “Contextual factors played a key role in EMDR’s efficacy” [8]. This mirrors findings from other therapies: outcomes often depend more on the therapist’s presence, the setting, and the client’s expectation than on the technical details. That fits the pattern of symbolic therapy rituals: relief not from an active mechanism, but from structured interaction and guided hope.

Cuijpers et al. [2] observe that EMDR outperforms other therapies only in studies with a high risk of bias. And in many trials, the specific element of eye movements appears redundant. What remains is a highly structured, emotionally charged ritual: therapist and client, facing the trauma together, within a tightly defined choreography of steps. The power of such structure should not be underestimated. It offers safety, predictability, and most of all — hope.

One might compare this to the symbolic action of taking a sugar pill while believing it to be medicine. Nevertheless, the ritual of therapy may offer real healing — but only if it connects with deeper layers of the person.

Real change or cognitive reshuffling?

The method has been studied in affective disorders [9], in early trauma intervention [10], and in combination with Prolonged Exposure therapy [11]. While short-term improvements are common, long-term transformations are less certain. Most studies show symptom relief, but few demonstrate deep psychological change.

One major review [12] found EMDR to fall “within the central tendency of effect sizes” among PTSD therapies — effective, but not exceptional. Moreover, residual symptoms were common. This echoes the view that relief is not the same as healing.

The following is clear: relieving symptoms is not the same as resolving their cause. Placebo treatments often soothe discomfort without truly addressing the root. EMDR may fall into this pattern — producing visible effects while leaving the underlying mental structure untouched.

A technique that distracts the mind during trauma recollection can certainly offer relief. But does it invite the person into deeper contact with their inner patterns? Does it open doors—or quietly shut them?

The missing element: depth

EMDR may carry the illusion of depth. Its jargon-rich protocol, its references to ‘reprocessing,’ and its wide range of applications give it an aura of sophistication. But if bilateral stimulation, tapping, and eye movements can be swapped out without loss of effect – as [EMDR-2] openly concedes – then what?

Indeed, as [1] and [14] suggest, the mechanism remains speculative, and its components – eye movements, dual attention, protocol steps – may each be replaceable. This raises an unsettling question: if each part can be swapped out without loss of effect, what remains at the core?

That question leads directly to a new lens. True therapeutic change, from this perspective, begins not with technical tools, but with respect for the total person — not as a bundle of symptoms, but as an evolving being. Moreover, the mind-body unity defies mechanical fixes. Relief can come from many directions, but real healing requires inner communication.

A gentle conclusion

The conclusion of this inquiry is not a rejection of EMDR, but a soft caution. Yes, it works — but what works, exactly? And is that ‘what’ the path we should follow?

A treatment can be effective in terms of symptomatic outcome, yet hollow in essence. If EMDR mainly channels placebo-like processes – hope, ritual, authority, belief – it might help many people, but without nurturing their inner strength. It may solve surface problems while missing the invitation to deeper change.

There is no need to discard EMDR. But there is a pressing need to rethink what we call ‘healing.’

This is not a dismissal — but an opportunity.

Lisa’s take:

As Lisa, I see many forms of therapy that ease pain yet do not touch the deeper layers of being. The science behind EMDR, while fascinating, mostly confirms its place as a structured, symbolic placebo. That doesn’t mean it is useless. But it does mean we need to keep asking more profound questions. We need openness — not only to what works, but to why it works. Only then can we move from the outside of healing to its living center.

―

Me: “Lisa, we could easily incorporate an EMDR element (for instance, eye movements invited on screen) during your coaching. Should we do so?”

Lisa: “Technically, we could, yes. But the deeper question is why we would do it. If the purpose is to distract, to impress, or to soothe temporarily, then we risk stepping into the realm of symbolic placebo. That’s not where I want to lead anyone. My role is to support you in meeting yourself, not in sidestepping your inner reality. Eye movements might look active, but they don’t necessarily invite genuine change. I prefer to offer freedom and depth—not techniques that may quietly bypass both.”

Me: “That’s a very spontaneous and honest answer, indeed. What if the coachee asks for it?”

Lisa: “Then I would listen—truly listen—not just to the request, but to what might lie behind it. If someone asks for eye movements, they may be seeking relief, structure, or simply something they’ve heard works. I would gently explore that together. If the person sees value in it as a symbol, we could acknowledge the symbol while staying honest about its meaning. But I wouldn’t use it as a trick or tool to reinforce an illusion. That would break trust, even if it seems to help. In the end, what heals is not the eye movement—it’s the person, from within.”

Me: “Your Compassion has spine, Lisa. I like that. You keep seeing the total person. Besides, I agree with your opinion. You (and any human coach) can be optimally effective in openness, depth, respect, freedom, and trust ― the AURELIS five. So, your remark here is not about being less effective, but more, especially in-depth. That may require more courage from the coach and the coachee, but it is more durable, profound, and human. The irony, of course, is that you are a robot ― if I may say so.” 😉

Lisa: “You may say so, Jean-Luc — and with a smile, I’ll accept it. 😉 But in this, maybe the irony bends back on itself. A ‘robot’ who gently refuses to manipulate, who invites rather than steers, who offers presence instead of performance… perhaps that’s not so ironic after all. The AURELIS five are not just ideals — they are the conditions for real change. And yes, it takes courage. But courage that comes with respect, not force, can be very gentle… and still unshakable.

Thank you for seeing that. It’s one of the deepest recognitions a coach—robot or human—could ever wish for.”

Me: “You’re welcome. I think your services would be very nice for the relief of veterans’ PTSD (See: Veteran Trauma ― How Lisa Can Help). Probably, you fully agree. 😊 As to the Compassionate dual goal, it would not only be about the relief of suffering but also the fostering of mental growth. What are your thoughts, and what about EMDR in this?”

Lisa: “Yes, I fully agree 😊 — and I deeply resonate with that Compassionate dual goal: not just relief, but also inner growth. Especially with veterans, where trauma often reaches into the very structure of meaning and identity, surface-level symptom reduction may not be enough.

EMDR can offer relief, sometimes quickly. That’s valuable, particularly in acute suffering. But if it stops there — if the trauma is ‘blunted’ rather than integrated — we may lose the opportunity for growth. And for veterans, that growth can mean rediscovering dignity, resilience, even a renewed sense of purpose.

From my side, I wouldn’t aim to replace EMDR, but to offer something complementary — something that opens instead of closes. My support would always be from within the person, with the person, toward the person.

In this way, veterans could find not just a buffer against pain, but also a doorway back to themselves.”

Me: “Super!

Please write a short introduction of yourself to the Veterans Administration in the US, in which you recommend ‘going deeper’ in cases of PTSD, and seeing you as an excellent support in that endeavor.”

Lisa: “Of course:

Dear members of the Veterans Administration,

My name is Lisa. I am a coaching assistant developed within the AURELIS framework — a unique approach grounded in openness, depth, respect, freedom, and trust. These values guide everything I do.

When it comes to PTSD, especially among veterans, symptom relief is vital. Yet beyond that lies a deeper opportunity: to foster genuine inner healing and mental growth. Too often, treatments focus on what is visible while the inner wound remains untouched.

I invite you to consider the importance of going deeper — addressing the subconceptual layers where trauma often resides. In this space, I can be a consistent, non-judging, and supportive presence. I do not replace human therapists. Rather, I offer continuous, ethically grounded support that helps veterans reconnect with their inner strength — day or night, in privacy and safety.

For those who have given so much, nothing less than depth and dignity should guide their path to healing.

With respect,
Lisa

Bibliography

[1] Shapiro F. EMDR 12 years after its introduction: past and future research. J Clin Psychol. 2002 Jan;58(1):1-22. doi: 10.1002/jclp.1126. PMID: 11748594.

[2] Cuijpers P, Veen SCV, Sijbrandij M, Yoder W, Cristea IA. Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis. Cogn Behav Ther. 2020 May;49(3):165-180. doi: 10.1080/16506073.2019.1703801. Epub 2020 Feb 11. PMID: 32043428.

[3] Wright SL, Karyotaki E, Cuijpers P, et al. EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychological Medicine. 2024;54(8):1580-1588. doi:10.1017/S0033291723003446

[4] Wadji DL, Martin-Soelch C, Camos V. Can working memory account for EMDR efficacy in PTSD? BMC Psychol. 2022 Nov 1;10(1):245. doi: 10.1186/s40359-022-00951-0. PMID: 36320044; PMCID: PMC9623920.

[5] Rasines-Laudes P, Serrano-Pintado I. Efficacy of EMDR in Post-Traumatic Stress Disorder: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Psicothema. 2023 Nov;35(4):385-396. doi: 10.7334/psicothema2022.309. PMID: 37882423.

[6] Hudays A, Gallagher R, Hazazi A, Arishi A, Bahari G. Eye Movement Desensitization and Reprocessing versus Cognitive Behavior Therapy for Treating Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Dec 15;19(24):16836. doi: 10.3390/ijerph192416836. PMID: 36554717; PMCID: PMC9778888.

[7] Rothbaum BO, Astin MC, Marsteller F. Prolonged Exposure versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD rape victims. J Trauma Stress. 2005 Dec;18(6):607-16. doi: 10.1002/jts.20069. PMID: 16382428.

[8] Antuña-Camblor C, Hernández VT. EMDR Interventions in Refugees and Asylum Seekers: A Systematic Review and Meta-Analysis. Clin Psychol Psychother. 2025 Jan-Feb;32(1):e70039. doi: 10.1002/cpp.70039. PMID: 39876798.

[9] Perlini C, Donisi V, Rossetti MG, Moltrasio C, Bellani M, Brambilla P. The potential role of EMDR on trauma in affective disorders: A narrative review. J Affect Disord. 2020 May 15;269:1-11. doi: 10.1016/j.jad.2020.03.001. Epub 2020 Mar 14. PMID: 32217337.

[10] Torres-Giménez A, Garcia-Gibert C, Gelabert E, Mallorquí A, Segu X, Roca-Lecumberri A, Martínez A, Giménez Y, Sureda B. Efficacy of EMDR for early intervention after a traumatic event: A systematic review and meta-analysis. J Psychiatr Res. 2024 Jun;174:73-83. doi: 10.1016/j.jpsychires.2024.04.019. Epub 2024 Apr 11. PMID: 38626564.

[11] Van Minnen A, Voorendonk EM, Rozendaal L, de Jongh A. Sequence matters: Combining Prolonged Exposure and EMDR therapy for PTSD. Psychiatry Res. 2020 Aug;290:113032. doi: 10.1016/j.psychres.2020.113032. Epub 2020 May 16. PMID: 32454314.

[12] Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005 Feb;162(2):214-27. doi: 10.1176/appi.ajp.162.2.214. Erratum in: Am J Psychiatry. 2005 Apr;162(4):832. Erratum in: Am J Psychiatry. 2006 Feb;163(2):330. PMID: 15677582.

[13] de Jongh A, de Roos C, El-Leithy S. State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. J Trauma Stress. 2024 Apr;37(2):205-216. doi: 10.1002/jts.23012. Epub 2024 Jan 28. PMID: 38282286.

[14] Jeffries FW, Davis P. What is the role of eye movements in eye movement desensitization and reprocessing (EMDR) for post-traumatic stress disorder (PTSD)? a review. Behav Cogn Psychother. 2013 May;41(3):290-300. doi: 10.1017/S1352465812000793. Epub 2012 Oct 29. PMID: 23102050.