EMDR vs CBT: How Do These Trauma Therapies Differ?
EMDR and CBT-based trauma therapies are both trauma-focused: each works directly with the memory of what happened and what it means to you. They differ in method. CBT approaches use talking, gradual exposure and written practice between sessions. EMDR pairs the memory with back-and-forth movement or sound and usually involves no homework.
Key points
Both EMDR and CBT-based trauma therapies are listed by the VA and the World Health Organization among well-supported PTSD treatments.
CBT-based approaches usually include practice or worksheets between sessions. EMDR does not require homework.
Prolonged Exposure involves talking through the trauma in detail. EMDR in most cases does not.
The sources we reviewed do not name a winner. The VA says no one treatment is right for everyone.
What is the main difference between EMDR and CBT for trauma?
The main difference is what you do with the memory. In CBT-based trauma therapy, you work on it through talking, writing and gradually facing what you have been avoiding. In EMDR, you hold the memory in mind for short periods while following a back-and-forth movement or sound.
Both belong to the group the VA National Center for PTSD calls trauma-focused talk therapies, which it describes as the treatments with the most research support for PTSD.
How does CBT-based trauma therapy work?
CBT stands for cognitive behavioral therapy. The National Institute of Mental Health (NIMH) explains that CBT for PTSD can include exposure therapy, which helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma, and cognitive restructuring, which helps people make sense of the traumatic event.
The VA describes two trauma-focused therapies that use these kinds of methods.
Prolonged Exposure (PE) works by helping you face your fears. You make a list of situations you have been avoiding and work through it step by step. Around the third session, you begin talking through the details of the trauma with your provider. Between sessions, you practice doing some of the things you have avoided. The VA says PE usually takes 8 to 15 weekly sessions of 60 to 90 minutes.
Cognitive Processing Therapy (CPT) teaches you ways to evaluate and change upsetting thoughts about the trauma, such as the belief that you are to blame for what happened. You talk about those thoughts with your provider and complete worksheets between sessions. Writing about the details of the trauma is optional. The VA says CPT usually takes 12 weekly sessions and can be done individually or in a group.
CBT is also used well beyond trauma. Our article on how CBT helps with anxious thoughts shows the same skills applied to worry.
How does EMDR work differently?
In EMDR, you call the upsetting memory to mind while paying attention to something that moves or sounds from side to side, such as your provider's moving finger or a tone that alternates between ears. You do this in short sets, then briefly say what came up.
The VA says that in most cases you will not be asked to talk about the details of your trauma, and that EMDR does not require homework or practice assignments between sessions. EMDR is offered one-on-one.
We explain the eight phases and what a session looks like in what is EMDR therapy.
EMDR vs CBT at a glance
These points come from the VA National Center for PTSD descriptions of each therapy.
Main activity: PE has you gradually face avoided situations and talk through the trauma. CPT has you examine and change upsetting thoughts. EMDR has you hold the memory in mind during back-and-forth movement or sound.
Talking about details: yes in PE, starting around the third session. Optional and in writing in CPT. In most cases not asked for in EMDR.
Between sessions: real-life practice in PE, worksheets in CPT, no required homework in EMDR.
Format: PE and EMDR are individual therapies. CPT can be individual or group.
Length: each is described as lasting about 3 months of weekly sessions.
What do EMDR and CBT-based trauma therapy have in common?
More than people expect. All three therapies are trauma-focused, meaning the treatment centers on the traumatic event and what it means to you instead of only managing symptoms.
The VA uses the same sentence for each one: it is one of the most effective types of treatment for PTSD. The World Health Organization likewise states that the psychological treatments with the most evidence for PTSD are cognitive behavioral therapy with a trauma focus and EMDR.
They also share the same main downside. Focusing on trauma memories or beliefs can be uncomfortable. The VA describes this discomfort as usually brief and says people tend to feel better as they continue.
Is EMDR or CBT better for trauma?
The sources we reviewed do not rank one above the other, and neither do we. The VA states that there is no one treatment that is right for everyone, and that you and your provider can decide together based on benefits, risks, side effects and your preferences.
A few questions can help you think about fit before that conversation:
How do you feel about homework?. If structured practice between sessions appeals to you, a CBT approach offers it. If it sounds like one more thing to fail at, that matters too.
How do you feel about talking in detail?. Some people want to say what happened out loud. Others are relieved to learn that EMDR usually does not ask for a full retelling.
Do you like to understand the reasoning?. CPT spends a lot of time examining specific thoughts. People who like to reason things through often find that format familiar.
What has been tried before?. If you have done one kind of therapy already, tell your therapist what helped and what did not.
How Balanced Life can help
At Balanced Life Counseling Services, some clinicians are trained or certified in EMDR and several use cognitive behavioral therapy. You do not have to choose before you call. Your therapist will talk through the options with you as part of trauma therapy at our Salisbury or Bethesda office, or by telehealth.
To ask which approaches are available for your situation, contact us. If you are in crisis, call or text 988 or call 911. Our office does not provide emergency services.
Frequently asked questions
Is EMDR faster than CBT?
The VA National Center for PTSD describes similar time frames. EMDR is described as about 3 months of weekly sessions. Prolonged Exposure usually takes 8 to 15 weekly sessions and Cognitive Processing Therapy usually takes 12, each lasting about 3 months. How long your own treatment takes depends on your history and goals, which your therapist will review with you.
Can I do both EMDR and CBT?
That is a question for your therapist, because it depends on your needs and on the training of the clinician you see. The pages we reviewed describe each therapy as a complete course of treatment and do not address combining them. Many people start with one approach and review progress with their therapist along the way.
Which therapy is better if I do not want to talk about what happened?
The VA says that in most cases EMDR does not ask you to talk about the details of your trauma. In Cognitive Processing Therapy, writing about the details is optional. Prolonged Exposure does involve talking through the trauma in detail from around the third session. Share your concern with your therapist so it can shape the plan.
Does one therapy have more homework than the other?
Yes. According to the VA, Prolonged Exposure includes practicing things you have avoided between sessions, and Cognitive Processing Therapy includes worksheets between sessions. EMDR does not require homework or practice assignments. Neither style is right or wrong. Some people value the structure of practice, and others prefer to keep the work inside the session.
Sources
If you are in crisis or thinking about suicide, call or text 988 (Suicide and Crisis Lifeline). In an emergency, call 911.