EMDR and CBT are highly-studied and recommended treatments for PTSD. Research has shown that both types of therapy can be effective for various presenting issues, such as anxiety or depression. The choice of therapy type will depend on your concerns, preferences about what to discuss and work on in therapy, and what your therapist deems most appropriate.
What Is EMDR?
EMDR is a type of psychotherapy initially developed to treat PTSD. Still, it also has the benefits of being helpful for other concerns, including anxiety, panic disorder, depression, addiction, OCD, and pain disorders.1
Specialists can perform EMDR in person or EMDR online. In EMDR, you focus on traumatic memories, challenging experiences, or current triggers while having bilateral stimulation, which facilitates your brain’s natural ability to reprocess and helps to decrease the emotion associated with the memory.2,1
EMDR is an effective treatment for the following:
- PTSD3,2
- Complex PTSD1
- Anxiety2,1
- Panic disorders and phobias (although more research is needed)4
- Depression5,6,2
- Addictions (when combined with other treatments in a drug court program)7,2
- Phantom limb pain8
- OCD2
- Chronic pain2,1
What Is CBT?
Cognitive behavioral therapy is a type of therapy that focuses on how thoughts and thinking patterns influence behavior. CBT is a well-researched and frequently used evidence-based treatment. Specialists can do this therapy in person or provide CBT online via telehealth. When CBT is administered correctly, it is highly structured, time-limited, and often involves homework assignments.
CBT is an effective treatment for the following:
- Depression9
- Anxiety and Generalized Anxiety Disorder10
- Panic disorder (with and without agoraphobia)11
- Social anxiety12
- Post-traumatic stress disorder13
- Insomnia14
EMDR vs. CBT: Key Differences
EMDR and CBT have concepts in common, especially since they both are talk therapies that aim to adjust negative self-beliefs. However, the content and structure of the two treatments are different. EMDR uses bilateral stimulation, a form of movement from one side of the body to the other, such as moving your eyes back and forth or tapping from one side to the other. This EMDR process promotes a natural reprocessing of events, beliefs, and triggers, while CBT focuses on negative thought patterns and automatic negative thoughts.
Cost Differences
The cost of either therapy will largely depend on things such as:
- If you have insurance coverage for mental health
- The type of insurance coverage
- The geographical area in which you’re seeking treatment
- The kind of specialty therapist you work with
These factors will influence your cost more than the specific type of therapy you use. However, both therapies are generally accepted as reasonable, evidenced-based treatments and are usually covered by insurance.
However, suppose there is a shortage of therapists in your area. In that case, you may have difficulty finding a therapist that takes your insurance, potentially leading you to pay the therapist their full fee rather than use insurance. Online therapy with your insurance may also be helpful if in-person options are unavailable.
The amount the therapist charges you out of pocket will depend on things such as:
- Their education
- Years of experience
- The going rate for therapists in your geographic area
Differences In Length of Treatment
Both therapies will require at least six sessions, likely more depending on the factors of presenting concerns. It is common for individuals to be in treatment for months to years, especially when working on healing from years of unresolved conflict. Therapy isn’t a race or always a quick fix; it is crucial to remember that the most effective therapy goes at a healthy pace that works for you.
The length of therapy will depend on factors such as:
- Your goals
- Mental health history
- How you respond to the treatment
- The number of presenting concerns.
For example, if you are being treated for complex PTSD, you may need some initial sessions to develop coping and self-soothing skills before embarking on the work in EMDR or CBT. When you are ready to work on the core of your trauma, it will take anywhere from 20 sessions or more.
When Are They Used to Treat Different Disorders
Both EMDR and CBT are effective for a wide variety of concerns. EMDR is more likely to be used and recommended for PTSD or traumatic experiences because it was initially designed to treat trauma and includes a wealth of research to demonstrate that it is a frontline treatment for PTSD.2,16
EMDR is also more likely to be used when a clear event or series of events directly influences mental health symptoms like abuse, a traumatic accident, or an unhealthy relationship.
Certain types of CBT, like CBT-I, are specifically designed to treat insomnia, a common symptom of PTSD. Therapists can utilize many other components of CBT to support trauma processing and healing.
Availability Between EMDR & CBT
The availability of CBT versus EMDR will significantly vary based on your geographic region and the training of the therapists in that area. CBT may be more available in some cases because it was developed 20 years earlier than EMDR. Many therapists may incorporate aspects of CBT into their therapy, whereas EMDR is typically used as a standalone intervention.
Differences In Certification & Training
For EMDR, therapists must complete at least basic training through EMDRIA-approved training. Do not work with a therapist who has not received at least basic training in EMDR.
EMDRIA is the organization that sets the standards for EMDR training and also provides Certification for therapists that have completed each certification step, including:17
- Basic Training
- Completed at least 50 sessions of EMDR with at least 25 clients
- Received at least 20 hours of consultation with a certified trainer
- Attained 12 hours of continuing education
CBT also has a certification program through the Beck Institute, named after the creator of cognitive behavioral therapy. Similar to EMDR, it is not recommended to work with a therapist that has not received some formal training in CBT.
To achieve the basic level of certification for CBT, therapists must complete certification steps, such as:18
- A variety of training in how to use CBT for various presenting concerns
- Demonstration of their skill through videotaped sessions
- Received supervision from a trained professional
In Session Experiences
A critical difference between EMDR and CBT, especially in the treatment of trauma or difficult memories, is the need to discuss the details of the trauma. EMDR does not require you to discuss the details of a memory.2
However, it is vital to discuss the details of traumatic memories in CBT, especially trauma-focused CBT. Discussing complicated events can be re-traumatizing and challenging for some who have experienced complex events. In some of these cases, EMDR may be preferable.
Again, EMDR will use some sort of bilateral stimulation, meaning a back-and-forth movement between two sides of your body.
This EMDR procedure, unlike CBT, can be done with techniques such as:1
- Eye movements
- Tapping on two sides of the body
- Walking meditation
- Beeps alternating between ears
Time Spent Out of Session
In most cases, CBT will have more homework. When delivered as designed, CBT is structured and includes important homework assignments encouraging you to take what you’re learning in session and practice it in the real world.
That’s not to say that EMDR does not require work out of the session; you will likely need to practice various calming and soothing skills to ensure that you can tolerate any potential distress that comes up during EMDR.
If your mental health condition makes it exceedingly difficult to complete large amounts of worksheets or homework, EMDR may be a better choice. As always, discuss with your therapist how they may adapt either therapy to best suit you.
How to Choose Between CBT & EMDR
There are many paths to healing, and each type of therapy will have its advantages and disadvantages. Therefore it is always best to discuss therapy options with a trained and licensed mental health therapist. Choosing Therapy has an online directory of therapists and can help you find the right therapist that is an excellent fit for your needs.
Regarding their approaches, EMDR may be better suited for mental health concerns where a specific past situation or memory led to a pervasively negative belief about yourself or the world. EMDR can help to reprocess these memories and adjust the subsequent views. CBT may best suit mental health concerns where negative thinking patterns drive your symptoms, impacting daily living. Even so, both types of therapy are remarkably flexible and helpful across a wide range of concerns.
Final Thoughts
CBT and EMDR are evidence-based treatments that can assist with various presenting concerns. The decision on which to choose may depend on what you want to discuss or focus on in therapy and what a trained mental health professional recommends for your circumstances.
For Further Reading
EMDR vs. CBT: Effectiveness, Differences, & When to Use Infographics
