EMDR or CBT? What the Comparative Research Tells Us

Anyone researching therapy for trauma quickly runs into the same question: should I choose EMDR or cognitive behavioural therapy? Both are recommended in national and international treatment guidelines, and both have decades of evidence behind them. So how do they actually compare? To answer questions like this, researchers use network meta-analysis, a method that pools results from many trials and compares treatments that may never have been tested head to head. Several such analyses have now looked at PTSD treatments. One of the largest, by Yunitri and colleagues, published in Psychological Medicine (2023), brought together 98 randomised trials involving more than 5,500 participants. It found that a range of therapies significantly reduced PTSD symptoms, including cognitive processing therapy, EMDR, cognitive therapy, narrative exposure therapy, prolonged exposure, and CBT. When the researchers looked at how well the benefits held up over time, EMDR stood out with a large effect at short-term follow-up. Other analyses paint a slightly different picture. A review by Jericho and colleagues in Acta Psychiatrica Scandinavica (2022) found the effect sizes of some cognitive therapies to be roughly double that of EMDR, and, as we have covered elsewhere, exposure-based therapies have outperformed EMDR in studies of military veterans specifically. Trauma-focused CBT also remains the most extensively researched option, with EMDR the second most researched. Reading across these findings, three conclusions seem fair. First, both EMDR and trauma-focused CBT work, and both work well. Second, the differences between them are generally modest, and which comes out ahead varies by study, by population, and by how the analysis is run. Third, no single therapy is best for everyone. That last point is the practical one. Rather than searching for an overall winner, it is more useful to think about fit. EMDR does not require detailed verbal description of the trauma, extended exposure, or homework between sessions, which some people find makes it more approachable. CBT offers a structured framework and a strong evidence base across a very wide range of conditions. If you are weighing them up, the most sensible step is a conversation with a qualified therapist about your circumstances, what you have tried before, and what you feel able to engage with. Both roads lead somewhere good; the question is which one you are more likely to walk down. Sources: Yunitri, N., Chu, H., Kang, X. L., et al. (2023). Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials. Psychological Medicine, 53(13), 6376–6388. Jericho, B., Luo, A., & Berle, D. (2022). Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis. Acta Psychiatrica Scandinavica, 145(2), 132–155.